Become a referrer
Please complete the form below

If you are a local health/welfare practioner and you would like to register with Willow Tree so you can refer families to our services please complete the form below and we will get in touch with you as soon as possible.  Please note that we work primarily in the London Borough of Barking & Dagenham and the surrounding areas.

Once your request has been approved you will then be able to use the online form to refer families to Willow Tree.

If you have any questions please don't hesitate to get in touch.



Organisation details

Organisation Name:*
Address, 1st line:*
Address, 2nd line:*
Postcode:*

Your details

Title:
First Name:*
Surname:*
Job Title:*
Phone:*
E-mail:*
Word Verification:

Data protection compliance - important!

Please read before completing the form

Willow Tree/Chadwell Heath Baptist Church will be processing data on your behalf so there must be a contract in place from the referral agency (the data controller) to allow us to do this legally.

We cannot approve your application without this in place.  You will be asked to send us a copy of your contract once your referral form is submitted. 

If you do not currently have a model contract, please visit the Information Commissioner's website for details of what must be included. 

 

 

Data privacy notice

To view details of how we store and process information please view our data privacy notice.

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Willow Tree supports families living in Barking & Dagenham and surrounding areas. It is run by Chadwell Heath Baptist Church.

Contact:    info@willowtreebaby.org.uk  |    Tel: 07411 374798   |    Chadwell Heath Baptist Church, 74-76 High Road, RM6 6PP

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