Making a referral on behalf of someone else

Before you refer someone, please make sure they meet the inclusion criteria below.

Please fill in our referral form if the person is:

living in Nottingham
experiencing any of the following: loneliness, isolation, anxiety, depression
in their own opinion they have mild to moderate support needs
able to make sessions to the best of their knowledge (Wednesday mornings at Windmill Community Gardens in Bobbers Mill)
able to get to the garden (we may be able to provide travel assistance soon via GreenSpace Green Buddies)
feeling they have ‘slipped through the net’
unemployed or underemployed / on benefits / low income
willing and able to do some gardening at their level (this could be gentle activities sitting down or more active gardening)

Please do not fill in the referral form is the person is:

living outside of Nottingham
experiencing severe mental, behavioural, addiction or physical health problems that will impact on their ability to attend or join in.
know this commitment to the project is too much for them at this time.
able to attend social or community gardens regularly on their own
on a high income
socially mobile

If you are unsure about the criteria above, please do get in touch with us.

Referral Form

The information I am providing in this form is true to the best of my knowledge and the person has given permission for me to share this information with Growing Forward.

The person has given permission for Growing Forward to contact them about their suitability as a participant in the Growing Forward sessions.

Referrer's information

Referrer name

Job title

Organisation

Contact number

E-mail address

Address

Person's information

Person's name

Date of birth

Contact number

E-mail address

Address

Emergency contact details (please give two names if possible)

Contact 1 name & relationship

Contact 1 number

Contact 2 name & relationship

Contact 2 number

Participation in Growing Forward

If the person you are referring needs more information about the group sessions and one-to-one sessions, please let us know and we can discuss further. The person may choose to use either option or both.

The person is interested in Growing Forward’s small group gardening activities

The person is interested in using Growing Forward’s one-to-one counselling / listening service

Support worker / key worker details

If the person has a key worker or support worker, please provide details here:

Name of worker

Job title

Organisation

Address

GP details

GP name

GP contact details

Health information

Please tell us about any health conditions the person has and any regular medication they take:

Please tell us about any allergies the person has. Do they have an EpiPen? If no allergies, please type 'None'

Do they feel that any of the above could affect their participation at Growing Forward?

If the answer to the above was yes, briefly describe what these difficulties might be. This will help us know the best way to help if there are any problems.

Interests / skills

Please tell us about any gardening experience or other interests and skills the person has. For example customer service, IT/computers, sales or construction. Please include hobbies & interests.

Would the person be able to make a contribution to your counselling sessions? Please choose an amount per session. There is no obligation to pay.

If you are human, leave this field blank.