Getting Support at The ClementJames Centre

Thank you for your interest in getting support at the ClementJames Centre. Please register below using the online form. Once you have completed the form you will be taken to a booking page. From here, you will be able to choose a time for a welcome meeting, and whether you would like it to be in person at the ClementJames Centre, or online, or over the phone.

Have you registered with The ClementJames Centre already?

Yes, I have completed an online registration form. Great! Click here to book an assessment.

No, I need to complete an online registration form. Please click "Next Page" below to complete the form.

Thank you for taking the time to fill out this referral form. If you need support filling out this form, or receive an error message that does not allow you to submit, please contact reception@clementjames.org or give us a call on 020 7221 8810.

Privacy Notice

At The ClementJames Centre, we’re committed to protecting and respecting your privacy.

Please see our privacy notice attached here, and tick here when you have read and agree to the terms laid out in it.

Who We Can Support

If you do not fit our criteria but would like our help to find an organisation who can support you, please contact reception@clementjames.org or give us a call on 020 7221 8810.

Please select the borough you are a resident of housed in:

We also have criteria that clients need to meet to access support. At least one of the following means that you are able to access support at the Centre.

Please select any of the following that apply to you:

Receiving benefits

Have a household income of less than £25,000

Living in social housing (this includes council, temporary accommodation and housing associations)

Child/ward receiving free school meals

Your Details

Title

First Name

Last Name

Date of Birth (dd/mm/yyyy)

Gender

Self-described gender:

Ethnicity

Other or self-described ethnicity:

Contact Number

House Number & Street Name

Post Code

How did you hear about The ClementJames Centre?

There are times when photographs of activities are taken for publicity and marketing purposes. This is really helpful for us to be able to show what we are doing in the community. Please tick here if you agree for your image to be used in this way.

Getting Support

If you cannot find the support that you are looking for but would like our help to find an organisation who can support you, please contact reception@clementjames.org or give us a call on 020 7221 8810. Please note that our Employment services are currently unable to take any new referrals - more information in the message above.

What is the main type of support that you would like to receive at ClementJames?

Please tell us, in as much detail as possible, what you would like support with:

What is your Information, Advice & Guidance enquiry regarding?

Which GP surgery are you registered with? (We ask this question due to criteria set by our funders. If you live in Kensington & Chelsea but your GP surgery is not reflected here, please select 'N/A'.)

Your Emergency Contact's Details

In the event of an emergency, it is really helpful for us to have someone we can contact for you. This could be a partner, relative, friend or your GP surgery, for example.

Emergency Contact Full Name

Emergency Contact Number

Your Language and Communication Needs

We ask the following questions in order to provide the best support for you throughout your time at The ClementJames Centre.

Do you have any learning or physical accessibility needs that we should know about?

Please provide us with more details:

Do you have any communication or language needs that we should know about?

Please provide us with more details:

Please tick here if you need assistance to exit the building in the event of an emergency evacuation. Staff will prepare a Personal Emergency Evacuation Plan (PEEP) for you.

Submit Your Form

Please submit the form below. You will then be taken to our website to book a triage meeting with a member of the team. In this meeting, you will be able to discuss your enquiry further and get triaged to the Wellbeing Team.

Contact Information

If you have any difficulties booking an appointment, please call 020 7221 8810.

If you work for an organisation looking to refer a client for support at The ClementJames Centre, please use the link to book your client in for a time that suits them.