• LGBT Foundation Services - Referral Form

    LGBT Foundation Services - Referral Form

  • Thank you for choosing LGBT Foundation as a service provider. This referral will take around 15-30 minutes to complete. You will need some relevant information to complete the referral form, including:

     

    • Name, date of birth, and address 
    • Contact details (email and phone) and consent to contact  
    • GP details, including the name of the GP surgery and its address 
    • Information on your needs, support being accessed, and support you wish to access  
    • General demographic information 

     

    Once your referral has been submitted, our team will review the information you share to ensure our services are the best fit for your needs and that you meet our eligibility criteria. You will receive an automatic email confirming we have received your referral and providing relevant information about the process.  Please note that we cannot review  all referrals immediately, but we aim to do so within 5-10 working days of receipt. If you feel like you need immediate support or that you are in crisis, we recommend that you make contact with one of the relevant services below:  

     

    • LGBT Foundation’s Helpline: Call 0345 3 30 30 30 or email helpline@lgbt.foundation. Our opening hours are Monday to Friday, 9 am-6 pm.  
    • Speak with your GP.  
    • If you are experiencing crisis or are at significant risk, contact 999 or attend your local A&E.  

     

    For other services you can contact, please use this link: Helpline and Email Support – LGBT Foundation 

  • Confidentiality

    We understand that confidentiality is important to those accessing our services. The information that you share with us will be kept in the strictest confidence and in accordance with the Data Protection Act (2018). In addition to the information you are reading here today, a member of our team will explain the exceptional circumstances under which confidential information may be shared during your assessment appointment. This would include situations where you or someone else is at risk of significant harm, or where there is a legal requirement in cases of serious criminal offences (in particular terrorism and money laundering). In such exceptional circumstances, we will always try to obtain your consent before disclosing any information, unless doing so would increase the risk, and we will do our best to support you in these instances. For further info on our policy, please get in touch with us at 0345 3 30 30 30. 
     
    By completing this form and signing the declaration below, you are stating that you understand and agree to the following: 
     

    • LGBT Foundation will collect information about you and the care you receive, which includes your referral form, assessment notes, paperwork related to the services that you access, and correspondence related to your care. 
    • My information will either be stored in paper form and/or in electronic records. All data collected is subject to the strict rules of confidentiality laid down by Acts of Parliament, including the Data Protection Act 2018 and the Health and Social Care Act 2001. 
    • LGBT Foundation may also get information about me from certain other organisations or give information about me to them: to make sure the information is accurate, prevent or detect crime or significant risk, and protect public funds. These organisations include local authorities, the police, and/or other healthcare professionals. 

  • Immediate Need or In Crisis?

  • Before you proceed to our full referral form, are you currently in need of immediate support or seeking crisis support?*

  • Based on our service offer, we are unable to meet this need at this time. We would recommend that you reach out to one of the following services as soon as possible:

     

    • Call 999 or attend your local A&E service.
    • Contact your GP and request an urgent appointment.

     

    Outside of these, there is a range of helplines that may be able to support, these include:  

     

    • NHS 111: You can access urgent mental health support by calling NHS 111 and selecting option 2. 
    • Samaritans: Offers confidential emotional support by phone, email or letter. Phone (24 hours a day): 116 123 (free), 0330 094 5717 (local call charges apply) https://www.samaritans.org/branches/manchester/   
    • Saneline: Saneline is a national out-of-hours mental health helpline offering specialist emotional support, guidance and information to anyone affected by mental illness, including family, friends and carers. They are normally open every day of the year from 4 pm to 10 pm, on 0300 304 7000. http://www.sane.org.uk/what_we_do/support/helpline/   
      SHOUT: SHOUT 85258 is a free, confidential, anonymous text 24/7 support service. You can text from wherever you are in the UK. 
    • Stay Alive App: The Stay Alive App is a pocket prevention resource packed full of useful information and tools to help you stay safe in a crisis. You can use it if you are having thoughts of suicide or if you are concerned about someone else who may be considering suicide. https://www.stayalive.app/find-help-now/  
    • PAPYRUS: PAPYRUS Prevention of Young Suicide is a UK charity dedicated to the prevention of suicide and the promotion of positive mental health and emotional well-being in young people. https://www.papyrus-uk.org/

     

    Please do come back and refer to our services once you have sought the support you need right now.  

  • Accessibility Need

  • Do you have any needs that would affect your ability to complete the referral form? (This could include physical conditions that make it difficult to type, cognitive and sensory needs such as dementia and visual loss, or other needs such as requiring an interpreter or translation)*

  • We would recommend that you contact our helpline by calling 0345 3 30 30 30 or emailing helpline@lgbt.foundation to let us know what support you require or to request support from our team to complete this form.

  • Locality

  • As a provider, we are only commissioned to work in certain localities. Currently, our services are open to community members living within the Greater Manchester Area. In addition, we can offer support, information, and advice to community members based in the City of Liverpool. To support us in ensuring you are in the catchment area for our services

  • Please click on the locality you are based in below*

  • Unfortunately, we are currently unable to offer ongoing support to people in your area. Despite this, we would recommend that you contact our helpline by calling 0345 3 30 30 30 or emailing helpline@lgbt.foundation. Our opening hours are Monday to Friday, 9 am-6 pm. A member of our team will be able to provide you with emotional support and brief advice, and, most importantly, up-to-date signposting to other support available to you in your area.

  • Service Overview & Age Restrictions

  • To support you in getting the best possible support for yourself or the service user you are working with, we wanted to provide information on the services currently on offer. This information can be found in the table below

  • Which service would you like to see the overview and eligibility criteria for?

  • Domestic Abuse Support

    Areas Covered - Greater Manchester (Manchester, Salford, Trafford, Stockport, Tameside, Bury, Bolton, Oldham, Rochdale, and Wigan) & Liverpool 

    Minimum Age Requirement - 16

    Service Overview - Our domestic abuse services offer support for individuals who are facing risk or danger from a partner, ex-partner, or family member. We also support LGBTQ+ people dealing with issues like honour-based violence, forced marriage, stalking, and control. The team provide both 1:1 support and group support for individuals affected by domestic abuse. This focuses on increasing safety, offering practical information and options, and providing emotional support. If you would like to speak to a member of the team before making a referral, you can email dasupport@lgbt.foundation 

  • Groups & Events

    Areas Covered - Each event will be delivered in different areas and have different eligibility requirements, so please check the event links for more information.

    Minimum Age Requirement - 18

    Service Overview - All groups and events delivered at LGBT Foundation are for community members aged 18+. As our groups and events regularly change or new ones are developed, you do not need to complete a referral to access. To find out more about our current groups and events running, you can visit the following page on our website: https://lgbt.foundation/events/  
     
    For each group or event listed, you can see who it is for and how to contact the relevant team to attend.

  • Helpline

    Areas Covered - National

    Minimum Age Requirement - No age requirement

    Service Overview - Our helpline provides emotional support, brief advice, and signposting. Anyone can contact our helpline, with no age or location restrictions. To access this service, a referral is not needed, and you can contact us by either calling 0345 3 30 30 30 or emailing helpline@lgbt.foundation. Our opening hours are 9 am-6 pm Monday to Friday.

  • Recovery Support

    Areas Covered

    For 1:1 Support - Manchester and Liverpool ONLY.

    For Group Support - Greater Manchester (Manchester, Salford, Trafford, Stockport, Tameside, Bury, Bolton, Oldham, Rochdale, and Wigan) & Liverpool

    Minimum Age Requirement - 18

    Service Overview - Our recovery programme currently provides 1:1 support group sessions. The programme is here to ensure that individuals find their own way to recovery and the relationship that they want with alcohol and drugs.  We are partnered with Change Grow Live and can also support access to mainstream structured and medical support.  
     
    If you would like to speak to a member of the team before making a referral, please email recovery@lgbt.foundation. 

  • Sexual Health Support

    Areas Covered - Greater Manchester (Manchester, Salford, Trafford, Stockport, Tameside, Bury, Bolton, Oldham, Rochdale, and Wigan) & Liverpool

    Minimum Age Requirement - 18

    Service Overview - Whether support is needed with navigating consent, using condoms and lube, learning about HIV prevention and the undetectable = untransmittable message, accessing PEP and PrEP, or getting tested for STIs, we’re here to help. We have a variety of guides and resources available, and our team is always on hand to talk about anything related to your sexual health or relationships.

    To access support from our sexual health team, you do not need to complete a referral form, but you can complete this form to get in contact with our team. 

  • Sexual Violence Support

    Areas Covered - Greater Manchester (Manchester, Salford, Trafford, Stockport, Tameside, Bury, Bolton, Oldham, Rochdale, and Wigan)

    Minimum Age Requirement - 18

    Service Overview - An Independent Sexual Violence Advisor (ISVA) is your guide in navigating the Criminal Justice System and provides support from report to court. ISVA act as a single point of contact through this experience and provides you with emotional and practical support. Alternatively, you may want to discuss reporting options with our ISVA, who can assist you with every step forward when you’re ready.

  • Talking Therapies

    Areas Covered - Greater Manchester (Manchester, Salford, Trafford, Stockport, Tameside, Bury, Bolton, Oldham, Rochdale, and Wigan)

    Minimum Age Requirement - 16

    Service Overview - Our talking therapies service currently offers both one-to-one and group support. These services provide a therapeutic, safe space for people to talk about a range of experiences, including but not limited to: navigating emotions in relation to identity, coming out, addressing relationship difficulties and identifying negative thinking patterns.

    For one-to-one support, we offer a range of modalities and practices, delivered by professionals trained in inclusive practice, to meet the varied needs of our community and support their mental well-being.

    Our service also currently offers two different groups, one on a Tuesday and one on a Thursday, bringing LGBTQ+ communities together in a therapeutic, safe space to talk about their experiences with peers.

    *It is important to note that we do not offer specialised therapies, i.e, Trauma-specific therapy.

    If you would like to speak to a member of the team before making a referral, please email therapy@lgbt.foundation.

  • Are the services you require provided within your area?*
  • Are you within the age category for the service you are looking for?  (16+ for Talking Therapies & Domestic Abuse Support, and 18+ for other services. The helpline does not require a referral, and anyone can access this)

  • Unfortunately, we are only commissioned to deliver services in the areas and to the ages outlined above. We’re sorry, but we're currently unable to support you in your area. We would recommend that you contact our helpline by calling 0345 3 30 30 30 or emailing helpline@lgbt.foundation. Our opening hours are Monday-Friday, 9 am-6 pm. A member of our team will be able to provide you with emotional support and brief advice, and, most importantly, up-to-date signposting to other support available to you in your area.

  • GP Query

  • Are you currently looking to access our talking therapies service (available for Greater Manchester residents only) ?*
  • Are you currently registered with a GP in Greater Manchester?

  • To progress your referral, we require you to be registered with a GP in Greater Manchester. We know that finding a GP can be difficult and come with some anxiety, especially as a member of the LGBTQ+ community. Due to this, we would recommend that you use the following link to find GP surgeries in your local area that have been trained by our Pride in Practice team and for more information on the training that they have undertaken: Pride in Practice – LGBT Foundation
     
    We are sorry that we are unable to accept your referral at this time. Please refer to our services once you have registered with a relevant GP surgery.  

  • Self or Service-to-Service Referral

  • Are you completing this referral for yourself or for someone else?*
  • Are you a professional working with the individual you are referring to?
  • Type of Organisation
  •  -

  • Information About The Person You Are Referring

  • Has the service user disclosed any risk to self, others, or others at risk?
  • Are you referring the client to domestic abuse support?
  • Have you completed a DASH RIC Assessment?  (As the professional taking this disclosure, you have the duty to complete a DASH RIC assessment and take actions where required)
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  • Unfortunately, we are unable to accept a referral from a professional to our domestic abuse services without a DASH RIC Assessment being completed and shared with us. Please get in touch with the service user, complete this assessment, and then refer them to our services. In the interim, they can still access our helpline service by calling 0345 3 30 30 30 or emailing helpline@lgbt.foundation. Our opening hours are 9 am-6 pm.

  • What are your pronouns?
  • Date of Birth*
     - -

  • In our services, we may need to email you relevant documentation or information regarding your appointments or support. Based on this, we require an email address for your referral.


  • Are you happy to be contacted following your time in our service to ask about your experiences with us? (You can opt out of this at any time by emailing optout@lgbt.foundation)*
  • Your data during your time in our services may be analysed internally to improve the service and included in reports, research, or other materials that are shared externally (for example, with funders, partners, or the public). Any information published externally will be confidential and anonymous.*
  • Format: 07000000000.
  •  -
  • Are you happy for us to… (select all that apply)
  • Preferred method of contact*
  • Would making a call to your number put you at risk of harm?*

  • As stated above, there may be times when we need to speak to other professionals regarding your support from our services. Often, this may relate to keeping you safe and ensuring you are getting the care required outside of what we will provide to you. Based on this, we need to ask the following questions:

  • Needs & Services

  • What ways would you feel comfortable accessing support?  Please select all that you are open to. It is important to note that waiting times may be higher for face-to-face requests.*
  • Do you require an interpreter to help you access our services?*
  • Which region do you live in?*
  • Greater Manchester - Which type(s) of support do you think would be useful? (Please select all that apply)*
  • Liverpool - Which type(s) of support do you think would be useful? (Please select all that apply)*
  • Our talking therapies service currently offers both one-to-one and group support. Please choose which options you are interested in accessing below

  • Talking Therapy Questions

    To ensure our talking therapies service is the best placed to support you, we require the following information

  • Over the last 2 weeks, how often have you been bothered by any of the following problems?

  • Domestic Abuse Questions

    If you are looking to access our domestic abuse support programme, please provide information for the service specific questions below

  • Sexual Violence Questions

    If you are looking to access our sexual violence support programme, please provide information for the service specific questions below

  • Domestic Abuse & Sexual Violence Questions

    If you are looking to access both our sexual violence and domestic abuse support programmes, please provide information for the service specific questions below
  • Was the sexual assault/violence recent or non-recent?

  • Please note: if the sexual assault was within 10 days you can contact a Sexual Assault Referral Centre for a forensic examination, emergency contraception, PEP and the first Hep B vaccination.

  • Approximate date of assault
     - -
  • Have you attended a Sexual Assault Referral Centre?
  • Have the police been involved?
  • If police have been involved, what is the status of the investigation?
  • Is the perpetrator known to you?
  • Perpetrator - Date of Birth
     - -
  • Does the perpetrator live at the same address as you?
  • Is there ongoing contact from the perpetrator?

  • Demographics & Submission

  • All of our services are free at the point of access, and we are always looking to develop new services to meet the needs of our communities. Most of the following questions are not mandatory; however, we would really appreciate it if you could share as much information as possible to help us understand who is accessing our services, identify what other services may be needed, and continue to keep our services free to access.

  • Which of the following options describes how you think of yourself?
  • Is your gender identity the same as when given at birth?
  • Intersex is an umbrella term for biological variations in sex traits or reproductive anatomy. These can be present at birth or develop as part of puberty. Would you describe yourself as intersex?
  • Sexual Orientation - which of the options best describes you?
  • What is your religion or belief?
  • Ethnicity - which describes you best?*

  • We ask the next question to help us to meet the needs of all of our service users. We want to make getting support from us as easy as possible. You do not need to have a diagnosis or have been to see a doctor about a disability to tell us how we can help you.

  • Do you consider yourself to be disabled and/or neurodivergent?*
  • (Optional) Describe your disability or disabilities by selecting the options available
  • What is your employment status?
  • What is your parent/guardian status (Please select all that apply)*
  • Have you ever been in the armed forces?*
  • Are you living with HIV?
  • Are you a carer?*
  • (Socio-Economic Background) Which type of school did you attend for the most time between the ages of 11 -16?
  • (Socio-Economic Background) If you finished school after 1980, were you eligible for Free School Meals at any point during your school years?
  • (Socio-Economic Background) What is the highest level of qualification achieved by either of your parent(s) or guardian(s) by the time you were 18?
  • Are you currently an active volunteer with LGBT Foundation?*
  • What drew you to LGBT Foundation's services?
  • How did you hear of LGBT Foundation?

  • You have now entered all the required information for us to process this referral. If you are happy with the information you have entered, please click the submit button below to send this referral to our team.

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