Referral form

Please complete the form below. If you want us to respond, you must provide a safe telephone number or email address.

Please note: you must complete all the fields (apart from last name, finance and benefits and specific access needs, which are optional).

First Name
Last Name
Email
Mobile
Preferred Pronoun:
Date of Birth (please enter as DD/MM/YYYY):
Gender Identity:
Trans or Trans History?:
Sexuality:
Ethnicity:
Disability:
Religion:
Pregnancy / Childcare:
Relationship Status:
Borough:
Economic Status:
Weekly Income (-Housing Benefit). If zero or nil income, please enter 0:
Are you in fear of a partner, ex-partner or family member?:
Housing Situation (Referrals for the Outside Project LGBTIQ+ Shelter specify here):
Support Required or Requested:
Specific Access Needs?:
Professional Filling in Form for Someone:

Please note:

Once you have submitted the form, you will return to our homepage. An email confirmation will be sent to the email address you have provided.

Weekly drop-in sessions

Every Wednesday :
14.00 – 15.30
Origin Housing
St Richard’s House
110 Eversholt Street
London NW1 1BS

Every Friday :
2.00-3.30 pm
London Friend
86 Caledonian Road
London N1 9DN

Monthly sessions (for trans people)
First Wednesday of every month, 17:00 – 19:00
CliniQ ,
56 Dean Street,
London, W1D 6AQ

All services are free and confidential and all the venues are accessible for people with disabilities. No appointments necessary. (Pre-arranged appointments can be made for between 15.30 and 17.00)

We review our drop-in sessions regularly to make sure we reach LGBT+ people across all London boroughs.

Monthly drop-in sessions

First Wednesday of every month: 5.30-7.00 pm
CliniQ
56 Dean Street
London W1D 6AQ
(for trans people)

All services are free and confidential.

All venues are accessible for people with disabilities.

No appointments necessary.

Pre-arranged appointments can be made for between 3.30 and 5.00 pm.