Warm & Well referrals

North Yorkshire Citizens Advice and Law centre is contracted by North Yorkshire Council to deliver Warm & Well in North Yorkshire.

Help is available 24 hours a day on the North Yorkshire Citizens Advice and Law centre Self-help page. This includes help if you are having problems with your energy supply or you are struggling to pay your bills.

If you are able to call us, please call the North Yorkshire Citizens Advice and Law centre Adviceline on freephone 0808 278 7900, Monday to Friday 9.00 am – 4.30pm.

Please help us to ensure we are able to help the people who need us most by using the online support and freephone Adviceline if you can.

You can make a referral to the Warm & Well team for yourself, or on behalf of someone (with their consent), by continuing to our referral form below.

We’re currently experiencing a very high demand for support; we aim to respond within 2 working days, and we’re working hard to respond within these times, please bear with us if this takes a little longer.

Thank you for your support.

Referral form

Are you completing this form for yourself or someone else?

Warm & Well self referral

Self referral questions

Warm & Well in North Yorkshire is only available in the following areas. Please select the area where you live. *

About your issues

Please tick all statements below that are applicable to you, to ensure the Warm & Well team provides the right support for you. *

I am worried about/cannot afford my energy bills or home fuel debt

I have problems heating my home

I live in a home with damp problems or mould

I live in a property with poor insulation

I would like general information on staying warm and well

I need advice/support switching my energy supplier

I need advice/support with something else

Please provide brief details of the issue and any action you have taken so far, including any key dates or deadlines. *

Your information

Title *

First name *

Last name *

Date of birth *

Ethnic group *

Health Condition *

Yes

Prefer not to say

Please provide additional information about your health condition where relevant to your issue(s)

Address *

Address

City / town / village

County

Postal code

Consent to contact by post

What is your current housing status? *

Phone *

Consent to contact by phone

Consent to contact by text

Consent to leave a message

Email address *

Confirm Email address *

Consent to contact by email

How many children are in the household? *

How many adults are in the household? *

Have you or a member of your household ever served in the military? *

Yes

Prefer not to say

Where did you hear/find out about Warm & Well in North Yorkshire? *

Is there any other information you would like to add?

Declarations

North Yorkshire Citizens Advice and Law centre are managing all referrals into Warm & Well North Yorkshire. Information provided on this form will be held securely on the database of North Yorkshire Citizens Advice and Law centre and shared with the appropriate Warm & Well in North Yorkshire service providers. Under the Data Protection Act 2018 you have the right to access this information.

In accordance with the Act, and in order to provide appropriate services, your information completed within this form will be shared with organisations working under the Warm & Well in North Yorkshire partnership. You can read the Data Protection Policies for North Yorkshire Citizens Advice and Law centre here. The policies include updated Privacy Policy in accordance with the General Data Protection Regulation.

I have read the Data Protection Policies *

I have read the Data Protection Policies, including the North Yorkshire Citizens Advice and Law Centre Privacy Policy, and give my permission for North Yorkshire Citizens Advice and Law centre to store my details and share them with the appropriate partner organisations, in order to make this referral for support to Warm & Well.

I give consent for North Yorkshire Citizens Advice and Law Centre to record the following special category personal data provided on this form.

Please tick the relevant boxes below to consent to us recording your special category personal data

Details of disability and health condition

Ethnicity

Religion

Sexual Orientation

Trade Union membership

Please note if you have provided your Ethnic group you will need to select the "Ethnicity" checkbox above to submit the form; if you have said "Yes" to the health condition question you will need to select the "Details of disability and health condition" checkbox above to submit the form.

CAPTCHA

If you are human, leave this field blank.

Warm & Well family/friend referral

Family/friend referral questions

For the purpose of this form, we will refer to the person you are making the referral for as “the client”.

Warm & Well in North Yorkshire is only available in the following areas. Please select the area where the client lives. *

About you

Your name *

Your email *

Confirm Your email *

Your contact number *

About the issue

Please tick all statements below that are applicable to the client, to ensure the Warm & Well team provides the right support. *

I am worried about/cannot afford my energy bills or home fuel debt

I have problems heating my home

I live in a home with damp problems or mould

I live in a property with poor insulation

I would like general information on staying warm and well

I need advice/support switching my energy supplier

I need advice/support with something else

Please provide brief details of the issue and any action taken so far, including any key dates or deadlines. *

About the client

Title *

First name *

Last name *

Date of birth *

Ethnic group *

Health Condition *

Yes

Prefer not to say

Please provide additional information about any health condition where relevant to the clients issue(s).

Address *

Address

City / town / village

County

Postal code

Client’s current housing status *

Phone *

Email address *

Confirm Email address *

I confirm that the client is happy to be contacted *

by phone

by text

a message can be left

by email

by post

Details consent *

I confirm that the client has given consent for these details to be shared with North Yorkshire Citizens Advice and Law Centre

How many children are in the household? *

How many adults are in the household? *

Has the client, or a member of the household ever served in the military? *

Yes

Prefer not to say

Where did you hear/find out about Warm & Well in North Yorkshire? *

Is there any other information you would like to add?

Declarations

I have read the Data Protection Policies *

Special category consent

I confirm that the client has given consent for North Yorkshire Citizens Advice and Law Centre to record the special category personal data provided on this form.

Please note if you have provided the client's Ethnic group, or said "Yes" to the health condition question you will need to provide consent for this information to be stored. If the client has not given consent, you will need to amend the answers to these questions.

CAPTCHA

If you are human, leave this field blank.

Warm & Well partner referral

Self referral questions

Warm & Well in North Yorkshire is only available in the following areas. Please select the area where the client lives. *

About your organisation

Organisation name *

Your name *

Your email address *

Confirm Your email address *

Your contact number *

About the issue

Please tick all statements below that are applicable to the client, to ensure the Warm & Well team provides the right support. *

I am worried about/cannot afford my energy bills or home fuel debt

I have problems heating my home

I live in a home with damp problems or mould

I live in a property with poor insulation

I would like general information on staying warm and well

I need advice/support switching my energy supplier

I need advice/support with something else

Please provide brief details of the issue and any action taken so far, including any key dates or deadlines. *

About the client

Title *

First name *

Last name *

Date of birth *

Ethnic group *

Health Condition *

Yes

Prefer not to say

Please provide additional information about any health condition where relevant to the client's issue(s).

Address *

Address

City / town / village

County

Postal code

Client’s current housing status *

Phone *

Email address *

Confirm Email address *

I confirm that the client is happy to be contacted *

by phone

by text

a message can be left

by email

by post

Details consent *

I confirm that the client has given consent for these details to be shared with North Yorkshire Citizens Advice and Law Centre

How many children are in the household? *

How many adults are in the household? *

Has the client, or a member of the household, ever served in the military? *

Yes

Prefer not to say

Where did you hear/find out about Warm & Well in North Yorkshire? *

Is there any other information you would like to add?

Declarations

I have read the Data Protection Policies *

Special category consent

I confirm that the client has given consent for North Yorkshire Citizens Advice and Law Centre to record the special category personal data provided on this form.

CAPTCHA

If you are human, leave this field blank.

Warm & Well referrals

Referral form

Are you completing this form for yourself or someone else?

Self referral questions

About your issues

Your information

Declarations

Family/friend referral questions

About you

About the issue

About the client

Declarations

Self referral questions

About your organisation

About the issue

About the client

Declarations

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