Online Referral Form

We take referrals for new clients directly from the following HIV support agencies and organisations:

• Brighton & Hove City Council
• University Hospitals Sussex NHS Trust
• Sussex Partnership NHS Trust
• East Sussex NHS Trust
• General Practice
• Terrence Higgins Trust
• Change Grow Live (CGL)
• Voluntary sector provider
• Other

Referring Organisations Information

Thank you for taking the time to refer your client to us.

Please complete the form below, which will be processed securely and confidentially using an SSL certificate – indicated by the ‘padlock’ symbol shown on this page of your browser. We are able to authenticate that this form has been sent by your organisation, and that the client is therefore eligible to use our service.We only need the minimum of client’s information on the referral form which we will corroborate with the client when they first use the service. Please do let us know if there are any special requirements, support needed, or whether your client would like us to contact them before they come for the first visit. We can make special arrangements for people to come along, including talking to them and meeting them before coming to the venue, and giving people a named contact when they come along.Please would you ensure all relevant fields below are completed.Thank you!