Refer someone

Make a Referral.

If you’re a professional and want to refer someone living with HIV in London please complete the form opposite. We will contact the client within three working days to discuss their needs and match them to the right Connect Well HIV support service(s).

By submitting the form you are confirming that you have received consent from the person you are referring to make this referral in accordance with our Privacy Policy and the General Data Protection Regulation. All information will be securely stored and someone will contact them as soon as possible.

t: 020 3137 3373

e: info@livingwellcic.com

Client Name

First Name

Last Name

Client Email

Client Phone

Select Client Borough

Reason for referral including any specific services required

Referrer Name

First Name

Last Name

Are you part of the Getting to Zero Collaborative?

Referrer Organisation

Referrer Email

Referrer Phone

Confirmation Required

I have read the Privacy Policy and received consent to make this referral