Support & Wellbeing Information Service Harrow (SWiSH)Referral Form

Eligibility Checklist
Ordinarily resident of Harrow / 18 years or over
Client Contact & Personal Details
Full Name / Title
Address
Postcode
Landline / Mobile
Date of birth / Male / Female
Email
Access Needs
Interpreter needed / Language(s):
Disability access needs
What information or advice is needed
Client Needs
Autistic spectrum / Mental health
Carer / Older person (60 years old +)
Dementia / Physical disability
Learning disability / Sensory impairment
Response time requested
Crisis
(today) / Urgent
(Next day) / Non-urgent
(3-5 working days)
Type of service requested
Phone / Email / Face-to-face
Client Risk Assessment
High risk / Medium risk / Low risk
Please provide details - Medium to High risk
Referrer – Contact Details
Staff name / Agency
Phone / Email
Client consent given to share this information

How to use this form is explained on page 2.

About the Support & Wellbeing Information Service Harrow (SWiSH)
Harrow Community Action (HCA) consortium is providing this service with 5 local charities: Age UK Harrow, HAD, Harrow Carers, Harrow Mencap and Mind in Harrow. This service has been commissioned by Harrow Council to provide a local Care Act 2014 Information & Advice Service.
Who our service is for
  • For anyone in Harrow 18 years and over who wants information or advice about local support services for and ways to keep safe and well.
  • As well as people looking for help for themselves, the service is open to carers and staff in local organisations.
What the service offers
We can offer information or advice about a wide range of local services, including: where to go to keep fit and well, manage finances, join social groups, look for work, start a course, access help with housing or welfare benefits or apply for a personal budget.
Our service does not offerfinancial advice, legal advice, advocacy 1:1 case support for welfare benefits and housing, but we can provide information about where to find this help. Please contact our service to find out more.

How to use the referral form

Please ensure the ‘Client consent given to share this information’ box is ticked before sending to the service. Thank you.

For referrals as a general enquiry, please send the referral form to Mind in Harrow:Mind in Harrow, First Floor, 132 – 134 College Rd, Harrow HA1 1BQ

Email: Tel: 020 8426 0929

If you would prefer send your referral one of our specialist information & advice services directly, their contact details are provided below:

For people who are 60 years and over and people with dementia
Age UK Harrow,3rd Floor, Premier House, 1 Canning Road, Wealdstone HA3 7TS
Email: Tel: 020 8861 7980
For people with disabilities
Harrow Association of Disabled People (HAD),The Wealdstone Centre, 38-40 High Street, Wealdstone, HA3 7AE
Email: l: 020 8861 9920
For carers
Harrow Carers, 376-378 Pinner Road, Harrow HA2 6DZ
Email: Tel: 0208 868 5224
For people with learning disabilities and/or autism and their carers
Harrow Mencap,3 Jardine House, Harrovian Business Village, Bessborough Road, Harrow HA1 3EX
Email: Tel: 0208 423 7382
For people with mental health problems
Mind in Harrow, 1st Floor, 132-134 College Road, Harrow HA1 1BQ
Email: Tel: 020 8426 0929
FOR OFFICE USE: Referral ID number

1