Referral Form

Please use this form to make a referral to the Freedom Matters Community Coaching Programme. We will be in touch within a week of receipt to discuss your referral further. Thank you. 

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* 1. Name of Referrer & Agency

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* 2. Referrer Contact Details

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* 3. Client details

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* 4. Preferred way to contact

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* 5. Client in agreement

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* 6. Reason for referral.
Please give as much detail as you can as to why you think the client referred will benefit from being part of the Community Coaching Programme. Please also indicate how you will support the client to be successful in this programme.

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* 7. Current situation
Please list any other support agencies involved with this client

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* 8. How ready for change is your client?

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* 9. Is the client currently employed?

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* 10. Accessibility

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* 11. Does the client have support from family/friends

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* 12. Any other relevant information you think we need?

Thank you for making a referral to the Freedom Matters Community Coaching Programme. If you have any further questions please contact us on 07761 405870 or email Jo Ibbott jo@freedomchurch.uk directly. We will be in contact to discuss this referral with you within a week of receipt. We will then contact the client directly to arrange a suitable time to meet and discuss further. 

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