Referrals

We accept referral from local authorities and homeless charities only

– if you are yourself looking for advice and guidance and fear homelessness please use our CONTACT US form. Alternatively we have listed some other organisations which may be of immediate assistance you can find them HERE

Please fill in this form fully – missing information will delay your application – we will check all I.D in an interview before we accept clients.

Your Name*

Your Email*

Your Phone*

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Name of the person you are referring

Age

Does the person have any of the following:
drug problemsalcohol problemsSchizopreniaHistory of Violence/AgressionPersonality DisorderAnxiety issuesLearning DifficultiesPrevious ConvictionsOther

Additional Information

Current Housing Situation

Brief Background of Mental Health History

Medical Information (Please can you provide any information on the persons current medication requirements)

Support Requirements

Useful Contacts (Please can you tell us about any professionals involved in the persons care, ie doctors, social workers, CPN's etc)

Funding Details (Briefly, describe who provideds the funding for the persons care?)

I give my consent for the information that I have given to be shared internally and between Onas Supported Homes and relevant agencies in order to access accommodation and services in relation to my identified needs.*
yes

It has been explained to me that this information will be held on a database, will remain confidential and will not be shared with any other agency without first seeking my permission.*
yes

I understand the only exception to this will be where we have serious concerns about the personal safety of myself or others. Example of there concerns include if I am contemplating suicide oOnas Supported Homesr self harm, if there is a genuine threat of violence against others, or where staff are summoned by a court order to give evidence.*
yes

Thank you for completing this form - we will email you a copy of the referral information and be in touch soon to arrange an interview where we can check Identification Documents and discuss further support needs and options available.

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