Course Referral Form - Well-City Salisbury

Thank you for being a referring/signposting partner to Well-City Salisbury. We hope that the creative courses and opportunities we offer will be of benefit to those you support. The questions below are designed to ensure that:

Referrers/signposters understand the participation criteria and have taken these into consideration when referring/signposting someone onto a creative course.

We have the correct information we need to make participants feel as safe, welcome and comfortable on the course as possible and to ensure their needs can be met on the course.

If you need any assistance in completing this form or have any questions about the form, the creative course you are referring someone onto or the Well-City Salisbury project generally, please get in touch with our Project Coordinator, Zoe, via email: wellcity.salisbury@wessexarch.co.uk. You can also get in touch on 07707 296883 Monday-Thursday.

The Referral/Signposting Process

Please complete all sections of this form and return it to the Project Coordinator by clicking submit at the bottom of the form/page.

Those you are referring/signposting onto a course will also need to complete the Applicant Enrolment Form (Signposted) and return it to the Project Coordinator. Please contact the Project Coordinator if you need a copy of this form.

A. Referral/Signposting Details

Name of person referred/signposted:

Phone number of above person:

Email of above person:

Course referred/signposted onto (e.g. name of course, course delivery organisation etc.):

Referrer/Signposter name:

Organisation and role:

Referrer/Signposter phone number:

Referrer/Signposter email:

B. Referral/Signposting Checklist

The questions below act as a check that our courses will be suitable for the applicant being referred/signposted. We know that these questions might not be relevant to all applicants, but our courses have been designed to support people with a range of mental health needs.

Please answer the following questions:

(Leave blank if not applicable)

Is there anything else we should be aware of in order to appropriately support the applicant and meet their needs?

C. Referrer/Signposter Confirmation

I confirm, based on the Well-City Salisbury referral/signposting criteria, the applicant’s suitability to participate in a creative course. I confirm I am aware of the applicant’s medical and health information and that, to the best of my knowledge, this form is an accurate representation of the applicant’s health status. I confirm that I will continue to act as a point of contact for support for the participant referred/signposted should it be necessary for the duration of the course.

Please tick to confirm you have read and accept the above Please tick to confirm you have read and accept the above