Make a Referral - Navigate Charity

Please indicate that the client consents to you sharing their information with Wiser£money 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 Wiser£money service:*

I Agree

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 Wiser£money service.*

I Agree

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

I Agree

That we will confirm to you whether they have engaged with the service or not*

I Agree

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 Wiser£money member of staff will provide the client with a copy of our Privacy Notice explaining in more detail what will happen to their data*

I Agree

Referrer Details

Agency Name

Your Name

Your Role

Phone Number

Email Address

Best Days and Times to Contact to Discuss

Date of Referral

Please tick here if you consent to receive updates on the project, you can opt out at any time. A copy of our privacy notice is available here: Privacy Notice
Information for the referrer: We will store your contact details for our records. This is kept for 12 years from the date money and/or debt advice is concluded or 2 years if it does not proceed.

Client Details

Client Full Name

Client Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Phone

Mobile

Email

Preferred Contact Method

Phone
Post
Email

To enable us to deal with the referral quickly and efficiently, please tick all that apply

You, the referrer, would like us to telephone you before making contact with the client to discuss the referral
The client is aware that a Wiser£money Adviser will make contact to arrange an appointment
You, the referrer, wish to be informed whether the client is engaged with the service or not
You, the referrer, needs to be present at the initial appointment to support the client

To enable us to deal with the referral quickly and efficiently, please tick all that apply.

Risk Assessment, please answer the following questions by ticking all that apply.

Are there any safety issues about visiting alone or being alone with the client?
Do you, or anyone in your agency visit the client alone?
Are there any safety or other risks that we need to be aware of?
If required, would you attend a joint visit with the client

If any risks are identified the Wiser£money Adviser will contact you to discuss.

Client Advice / Support - Please tick all that apply.

The client referred will continue receiving advice/support from you, the referring agency, while working with the Wiser£money service.
Wiser£money can refer the client to you, the referring agency, upon case closure from the Wiser£money advice service for ongoing advice/support.

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Referral Form

For agencies referring

For ALL referrals (self or from agencies)