Request housing advice for yourself

Fair Processing Notice
To find out how we will process and use personal information in connection with this request please see our Privacy Statements.

Keeping you safe - all adults and children have the right to be safe from harm. If you are worried about yourself, or someone else, being at risk of harm / abuse, including neglect, then it is important to tell someone. If they are in immediate danger, phone 999. If they are not in immediate danger, you can contact report your concerns to Health and Social Care Connect on 0141 287 0555 or, for adults, complete an support enquiry/referral.
Is your request urgent?
If you are unable to fill out the online form, and your situation is urgent, you can phone to arrange for someone to complete the form with you:
During office hours you can phone Health and Social Care connect on 0141 287 0555
Outwith office hours (after 4:45pm Monday to Thursday or 3:55pm on a Friday and at weekends) you can contact emergency homelessness services on 0800 838 502
About you
1. Name*
2. Surname*
3. Preferred Name
4. Date of Birth*
5. National Insurance Number
6. Address*
7. City
8. Postcode
9. Is there any additional information we need to know about the property?
10. Please tell us how you would prefer us to contact you?
  
  Phone
  
  Email
  
  Letter
11. Phone number (no spaces)*
12. Email Address*
  Please tell us your email address - if you do not have one, then type N/R (for Not Relevant) in the box
13. Gender - If you wish to tell us your gender, please choose from below
14. To follow up your request, we may need to contact you. Is there anything we need to know in terms of your language requirements
15. CHI number (this is your 10 digit Community Health Index number)
16. Immigration Status (if relevant)
17. Next of Kin
18. Next of Kin Address
19. Next of Kin Phone
20. How is your Next of Kin related to you?
21. In addition to the yourself, is there anyone else in your family who should be included in this referral?
  
  Yes
  
  No
22. How many family members should be included in this referral?
  
  1
  
  2
  
  3
  
  4
  
  5
23. Additional Family Member 1
  
  Name of the family member
  
  Surname of the family member
  
  Family members Date of Birth
  
  Please tell us the family members age if you don't know their DOB
24. Additional Family Member 2
  
  Name of the family member
  
  Surname of the family member
  
  Family members Date of Birth
  
  Please tell us the family members age if you don't know their DOB
25. Additional Family Member 3
  
  Name of the family member
  
  Surname of the family member
  
  Family members Date of Birth
  
  Please tell us the family members age if you don't know their DOB
26. Additional Family Member 4
  
  Name of the family member
  
  Surname of the family member
  
  Family members Date of Birth
  
  Please tell us the family members age if you don't know their DOB
27. Additional Family Member 5
  
  Name of the family member
  
  Surname of the family member
  
  Family members Date of Birth
  
  Please tell us the family members age if you don't know their DOB

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Request housing advice for yourself