Skip to main content
  • Text size
  • Change contrast

Partner agency referral form

If you a work for a partner agency and you would like to refer a customer to WIN Independent Living and Wellbeing in the Community, please complete the form below.

Guidance notes

1. Mobility and independence
In order to access our service, individuals need to be able to leave their property and access the community. (Unfortunately we are unable to provide any physical support or personal care needed).

2. Risk
Sometimes the information on this form is all we have to work with and our team work independently out in the community. Please include anything you feel is relevant for someone to know who may be working 1:1 in an individual’s home. A risk assessment may also be required on request in certain cases.

The information provided is confidential and will be used to process the referral accurately and efficiently.  Please complete the form fully.

WIN Living Well Referral Form

For example, access social lunch groups in area where they live learning a new skill like IT sessions, pre-work support like creating / updating their CV, or volunteering opportunities near to where they live etc.
For example, do they have a car? Do they use ring and ride or Stockport Car Scheme?
Please read guidance note 1 before completing.

Details of referral agency

Please complete the details below for the referral agency completing this form.

Share this page:
Page last reviewed 19/07/2017