Support Referral Form


Date of Birth

Reason for referral

What would you/the person being referred like to see happen as a result of the referral?

Does the person being referred know about this referral?
Details of person making the referral (if different to above)


Relationship to the person being referred

Contact telephone number

Email address (required)

By providing the above information, you consent to Greenfields processing your data as part of the referral process for Greenfields Housing Related Support Service. The information you have provided will be sent to our Housing for Older People Team and you will then be contacted regarding your referral. This information will also be used to update our Housing Management and Document Management systems.

You are able to withdraw your consent at any time by contacting Greenfields’ Housing for Older People Manager. However, please note that we are required to retain the information regarding your referral for the life of your tenancy, as per our Data Retention Schedule. For further information please see Our Privacy Policy.