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SHINE referral questionnaire

SHINE (the Seasonal Health Interventions Network) is run by Islington Council and available to any London household struggling to heat their home. The Council will use the information you provide for the purpose of giving free energy advice and, where relevant, making referrals into suitable services.

We will share the information with other Council departments/external bodies – there are many service providers in the SHINE network who can offer support with benefits, home energy visits, fire safety, energy efficiency grants, falls assessments and much more to help keep you well and warm at home.

We will always process your information in accordance with the law - for more information on the basis on which we process, use and store your information, please refer to the Council’s Privacy Policy.

Please complete the form below to refer into SHINE London. If you have any questions please call the SHINE on 020 7527 2001 or email shine@islington.gov.uk. 


Please complete these fields

Householder Details

Reason For Referral

Household Tenure


  1. Has client had any benefit problems (e.g. refusals, trouble applying)?

  1. Please describe the household structure


  1. Please state the householder's ethnicity

  2. If you have selected 'Other' please specify

Referred By

  1. Landline or mobile