PRG Referral Form

*Important Update*

Once this referral form is received we will contact you to arrange an initial assessment.

We are currently working through an influx of referrals. We anticipate waiting times to be longer than usual.

If you have any questions about this form please contact the PRG Team on 01452 529866.

Wherever possible please email if you have any queries.

PRG Gloucester TEL: 01452 529866   Mon – Friday (9:00 am – 5:00 pm)


Email address
Who is this referral for?
Agency details
Service user details
Risk Information

Splitz Support Service, Oak House, Epsom Square, White Horse Business Park, Trowbridge BA14 0XG
Registered Charity No: 1064764; Registered in England, Company Limited by Guarantee No: 3360057
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