Simply Connect

Introducing the Nature Consortia

The Nature Consortia is made up of 3 organisations who all support and aim to alleviate mental health stresses through nature based activity.

Open Minds Active - provide swimming-based wellbeing activities across Bristol, connecting people with nature in blue spaces to improve mental health and reduce social isolation.
Soul Trail Wellbeing C.I.C a not-for-profit offering inclusive nature trails and workshops to communities who need it most.
Active Being - Using physical movement to connect with others, through a range of programmes including nature, and creativity in local green and blue spaces.

We keep people’s information safe by following data protection law. If you would like to know more about the information we hold, please ask us. We have a privacy policy on our website.

Please enter the personal details of the person you are referring into our service

First name *

Last name *

Enter the postcode to search for the address

Address line 1 *

Address line 2

Town/City *

Postcode *

County

Country *

Mobile number *

Can we leave a message? *

Yes

Email Address

Date of Birth *

Identified gender *

Ethnicity *

What is your sexual orientation?

Feel free to self describe your sexual orientation here.

Does the person being referred need an interpreter? *

Yes

Languages spoken

Are you happy for us to connect you with partner organisations who provide interpreting services?

Yes

Emergency Contact Name *

Emergency Contact Phone Number *

Details of the person making the referral

If you are self-referring, please enter your own details here.
If you are referring someone else, please provide your contact details.

I'm referring myself

Yes

Referral details

These are the details regarding the referral.

Has the client given explicit permission for us to contact them?

Yes

Since no permission has been granted we cannot act further

Please obtain the client's permission and re-submit the form.

Reason(s) for Referral? *

Reason for Referral - Other

Please give a brief description of this referral. *

Please indicate which of our services you would like to refer into.

Soul Trail Wellbeing - Nature connection programme (6 week programme)

Soul Trail Wellbeing - 1-2-1 walk and talk

Open Minds Active - Wild Swimming for wellbeing (6 week programme)

Activebeing - 1-2-1 Walk and Talk in Nature

Relevant health history

These are details about the person being referred.

Do they have any existing health conditions? *

Yes

Choose existing health condition (you can select more than one)

Please provide any additional information relating to your health condition.

Do they have a disability? *

Yes

Choose disability (you can select more than one)

Do they have any other accessibility, communication or support needs?

Additional Factors

These are details about the person being referred.

Does the person have any unspent criminal convictions or cautions? If yes please give details *

Yes

Details

Please give any further information regarding any concerns that you think it would be useful for us to know.

Have they been engaged in a group setting before? If so, describe their experience. *

GP Surgery/Care agency details

These are details about the person being referred.

Select GP surgery

Who is their GP? (if known)

What's their NHS Number? (if known)

Thank you for taking the time to complete this form. A member of the team will be in touch from the relevant service provider to inform of the next steps for the activity.

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Social Prescribing Referral Form

Introducing the Nature Consortia

The Nature Consortia is made up of 3 organisations who all support and aim to alleviate mental health stresses through nature based activity.

Open Minds Active - provide swimming-based wellbeing activities across Bristol, connecting people with nature in blue spaces to improve mental health and reduce social isolation.

Soul Trail Wellbeing C.I.C a not-for-profit offering inclusive nature trails and workshops to communities who need it most.

Active Being - Using physical movement to connect with others, through a range of programmes including nature, and creativity in local green and blue spaces.