Referral Form

For agencies referring

Please indicate that the client consents to you sharing their information to access the services we provide and that you, as the referring party, have explained to the client and they agree and understand the following information in order to refer to the service:

That personal and sensitive information may be provided by you (the referring agency) about the client(s) in order to make a formal referral into the service.

For ALL referrals (self or from agencies)

That personal and sensitive data will be shared on a need to know basis in order to make an appropriate referral.

That personal information may be kept in a file or on computer. If money and/or debt advice doesn’t proceed, personal data will be destroyed after 2 years. If money and/or debt advice does proceed, a member of staff will provide the client with a copy of our Privacy Notice explaining in more detail what will happen to their data.

  • Referrer Details
  • Date Format: DD slash MM slash YYYY
  • Client Details
    To enable us to deal with the referral quickly and efficiently, please tick all that apply.
    If any risks are identified the Wiser£money Adviser will contact you to discuss.