Home Comforts Referral Form

Operated by Diamonds in the Community (SC049275)

Referring Partner Details

Phone Number

Are you happy for us to store your details for analysis?

Date of Referral Submission

Date of Collection Requested

Pick up/Delivery? (Donation required for delivery)

Has family been referred to any of the below agencies for help?

Financial Inclusion Team Welfare Fund Social Work CAB

Number of Adults in Household

Number of Over 65's in Household

Number of Babies in Household (under 2)

Number of Children in Household (2-16)

Please enter a number beside each item needed

Suite (state 3 or 2 piece)

Dining Table and Chairs (for how many?)

Crockery and Cutlery

Miscellaneous Requests/Comments

Comments (To be completed by DITC Member)

Referral Complete by

Notes

Self Referrals will only be accepted if agreement is given to be referred to Financial Inclusion Team and/or Citizens Advice first. Our referral form is secure, we do not need names. If preferred, the professional referring can simply put their own name for collection purposes. We will not pass the details of the family to anyone else; the only information we will ever share is the number of cots, buggies, bundles of clothes etc that we have given out in the past year. We aim to respond to all queries and referrals within 48 hours. If you have any questions or an urgent request, do not hesitate to email us.

Monklands Baby & Family Clothing Aid is operated by

Scottish Registered Charity No. SC049275

Monklands Baby & Family Clothing Aid
29 Graham Street
Airdrie
ML6 6DD
Open Mon, Wed, Fri 10am till 2pm
diamondsitc@hotmail.com

Baby and Family Clothing Aid Referral Form

Home Comforts Referral Form

In accordance with the current data protection laws, please take a minute to review the term & conditions for using our services. Our terms describe how we use data and the options available to you.

Operated by Diamonds in the Community (SC049275)

Home Comforts Assistance

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Referral Forms