Service application and referral information

On this page you can download the referral form. This form should only be completed and sent off to in touch with the applicant's knowledge and consent.

Our floating support service welcomes self referrals, or referrals from concerned family or friends, if you want more information please do not hesitate to contact us on 0845 6027895, or click here to complete a contact web form and we'll come back to you.

Referral Form

Click here to download the referral form in Word format

To submit your form to us, you can either download the form, print it off, fill it in by hand and post it back to the address below or you can fill it in electronically and email it back to southendfloatingsupportservice@familymosaic.co.uk

To return the form by post, send it to:
Southend Floating Support Service
Suites 3 & 4, Strand House
742 Southchurch Road
Southend on Sea
Essex SS1 2PS

If you have any questions about the referral and risk forms then you can contact the service by calling 0845 6027895 or fax us on 01702 461565.