St Mungo's Opening doors for homeless people

• Name (if known)
• Age (approx or DOB if known)
• Ethnicity
• Skin colour
• Gender: Male Female Unknown
• Hair (colour, long/short, bald or facial etc.)
• Approximate height
• Other identifying features

• Borough* Southwark Westminster Ealing and Reading
• Name of street
  Full description of sleeping site (e.g. shop doorway, stairwell of block of flats, under bridge etc.) If you are unsure of the exact location, please visit SteetMap
• Length of time at this location? (if known)
• What times are they usually here?

• Are you aware of any risks that this individual may pose to themselves or other members of the community?*

  Yes No Don't know

• If yes, are they a risk to:

  others themself
• Please give any information that would enable staff to safely contact or approach the individual

• Are they aware of this referral?*

  Yes No Don't know

• Are you aware of any specific support needs?

  Drugs/substance Alcohol Health Mental health Elderly Young

• Your name
• Organisation/Agency (if applicable)
• Your contact number
• Your email address

We will only use your details if we require more information from you.