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  • LGBT Foundation Services - Service to Service Referral Form

  • 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 or Liverpool areas including:

    • Manchester
    • Salford
    • Trafford
    • Bury
    • Bolton
    • Oldham
    • Tameside
    • Stockport
    • Rochdale
    • Wigan
    • Liverpool

    If they live in one of the localities listed above, our services are available via remote and in person including phone, and online platforms.

    We are also able to offer sexual health support, information, and advice for community members who are based within the City of Liverpool.

  • Unfortunately, if they are outside of Greater Manchester or Liverpool we are currently unable to accept their referral to our wellbeing services. For more information on what services are available in their area, or to get brief emotional support and signposting, please contact our helpline by calling 0345 3 30 30 30 or emailing helpline@lgbt.foundation

  • LGBT Foundation Services - Serive to Service Referral Form

    Please complete the form below to access our wide range of wellbeing services. Once you have submitted this form, we will invite the service user to our building for an assessment. All of our services are free at the point of care and we are here if you need us.

    Confidentiality

    We understand that confidentiality is important to our service users. The information that you share with us will be kept in the strictest confidence and in accordance with the Data Protection Act (1998). During the Intake and Assessment meeting, a member of the Services Team will explain to the service user the exceptional circumstances when confidential information will have to be shared, for example, if they or somebody else is at risk of significant harm or where there is a requirement in law in the case of serious criminal offences (in particular terrorism and money laundering). In such exceptional circumstances, we will try to get their consent before disclosing any information if that is possible and do our best to help them. For further info on our policy please contact us at 0345 3 30 30 30.

    By completing this form and signing the declaration at the end, you understand and agree to the following;

    LGBT Foundation will collect information about you and the care you receive, this includes your referral form, assessments 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 that is collected is subject to the strict rules of confidentiality laid down by Acts of Parliament, including the Data Protection Act 1998, 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.

  • Referrer Details

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  • Service User Details

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  • By providing their phone and email details, they are giving us consent to contact them via these methods - if this would cause any risk to them, please give an overview below.

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  • If they do not have a GP, when the referral is received we will be in contact to support them in getting access to one.

  • You have requested support on behalf of the person you are referring to find a GP that is best for the them. We will share their details with our Pride in Practice team who will be in contact with them to support them through this process.

  • Demographics

  • 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.

  • Their Needs & Goals

  • Our Services Explained

    • Talking Therapies - This service aims to provide the safe space needed to discuss emotions and identify strategies to maintain mental well-being. 
    • Domestic Abuse Support -  The service offers support for individuals who are facing risk or danger from a partner, ex-partner, or family member. 
    • Sexual Violence Support - Our Independent Sexual Violence Advisor (ISVA) can provide support and information to people who have experienced Sexual Violence and Abuse. 
    • Recovery Support - Our Recovery Programme is here to ensure that individuals find their own way to recovery and the relationship that they want with alcohol and drugs.   

  • Domestic Abuse Questions

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

  • Sexual Violence Questions

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

  • Domestic Abuse & Sexual Violence Questions

    If they are looking to access both our sexual violence and domestic abuse support programmes, please provide information for the service specific questions below

  • If you are a professional making a referral for a service user to access our domestic abuse support, there is an expectation that you must of completed a DASH RIC Assessment with the service user within a 48 hour window of their disclosure. In order for your referral to be accepted, please use the following link to complete the DASH RIC assessment or to input the information from the one you have previously completed:

    LGBT Foundation DASH RIC Form

    If a referral is received but no DASH RIC is completed, this may lead to the referral being rejected. Until this is accepted, you will hold the duty of care for the service users safety. If you have any questions about this, please contact dasupport@lgbt.foundation

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

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