We accept referrals from homeless organisations or government agencies only.

If you are currently homeless and not in contact with any other organisation and you are looking to gain support to help move forward we can sign post you to someone who can help with your direct needs. Please contact us.

Organisations and Goverment agencies can make a referral via the following online form – please ensure you have all the clients relevant information before submitting this form – if the form is incomplete we may not be able to process the referral.

We are able to offer support to a number of clients with a broad range of support needs including:

  • Ex Offenders
  • Abuse sufferers
  • Recovering Addicts
  • Mentally ill
  • Learning Difficulties

Risk Assessment

Please help us understand the clients needs by selecting which risk factors apply. Please think broadly about each statement.
Select all statements that apply – Leave blank if no risks and please add in any specific information to best help us understand the clients support needs.

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Risk of harm to self
Please help us understand the clients needs by selecting which risk factors apply. Please think broadly about each statement. Select all statements that apply - Leave blank if no risks and please add in any specific information to best help us understand the clients support needs. Risk of harm to self
Risk of harm to others and property
Risk of harm to Staff
Risk of harm to property
Lone Working
Please state the level of lone working risk.
Please use this space to detail what you would like to happen in a crisis situation. Please remember that Orchid Supported Homes has a duty to contact other services in certain emergency situations
We aim to offer as much support as possible, please use the next section of this form to help us assess the support needs of the client. Please provide as much information as possible. If a section does not apply please leave blank.
Housing
Help with finding and maintaining a home, help with living with others and working on to independant living
Finances
Help with benefits, managing money, paying bills and debt issues
Physical health and wellbeing
Help with diet, exercise, self harm and medical appointments etc
Mental Health and Wellbeing
Help with managing free time, social situations, depression, anxiety, or other mental health issues.
Substance missue
Help with managing addiction
Offending behaviour
I need help with offending behaviour, violence, aggression, stealing or other offences
Domestic Abuse
Please let us know of any current support you recieve along with any support needs you have
Legal Support
Areas not covered previously under offencive behaviour, such as divorce, child visitation, asylum etc
Disability Needs
Help us understand any additional disability needs you have to help us better support you, include any physical disabilities and learning disability
Confidentiality and Consent. I give my consent for the information that I have given to be shared internally and between Orchid Supported Homes and relevant agencies in order to access accommodation and services in relation to my identified needs.
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
I understand the only exception to this will be where Summerhill Care has serious concerns about the personal safety of myself or others. Example of there concerns include if I am contemplating suicide or self harm, if there is a genuine threat of violence against others, or where staff are summoned by a court order to give evidence.
Thank you for completing this form.
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