Connect Well

Boroughs:

Barking and Dagenham, Barnet, Bexley, Brent, Bromley, Camden, Croydon, Ealing, Enfield, Greenwich, Hackney, Hammersmith and Fulham, Haringey, Harrow, Havering, Hillingdon, Hounslow, Islington, Kensington and Chelsea, Kingston upon Thames, Lambeth, Lewisham, Merton, Newham, Redbridge, Richmond upon Thames, Southwark, Sutton, Tower Hamlets, Waltham Forest, Wandsworth, Westminster

Connect Well is a project run by Living Well CIC, a mental health and wellbeing charity currently offering free online and telephone support services to help improve the mental health and emotional wellbeing of lonely or isolated Londoners who are HIV positive.

Your details

First Name *

Last Name *

Address * Line 1

Address Line 2

Post Code *

Borough or Local Authority *

Date of Birth

Telephone *

Outline of support need * Please let us know why you are seeking support from this partner here.

Name of the organisation you are making a referral to * You can find this at the very top of this form.

Full Name *

Role Title *

Telephone *

Email *

By ticking this box and submitting this form you are consenting to all of the data you have inputted into this form to be sent the support agency named above and Notting Hill Genesis. If you change your mind, you can withdraw consent at any time by contacting your Housing Officer. *

By ticking this box and submitting this form you are consenting to the support partner named above to let Notting Hill Genesis know the progress of your support. If you change your mind, you can withdraw consent at any time by asking the support partner.

Are you human? *