For Registered Referrers Only- Make A Home Delivery Request
North Paddington Food Bank will be changing our operations from 31/03/21.
-Service days will be Wednesday, Thursday and Friday Only.
-Deliveries to South Westminster and the Congestion Zone will be made on Thursdays only.
-We will not be able to action referrals on the same day except in extreme emergencies.
-Only customers with extremely limited mobility due to age or disability will be eligible for deliveries. We strongly encourage our customers to ask for food collections wherever possible as we have significant
pressure on a small pool of volunteer drivers who make deliveries.
-We are currently only carrying out home deliveries and collections for people who are unable to afford food. --
Those with the financial means should be signposted to shopping services.
-We are working with the CAB to support our customers to independence from this service, where CAB referrals
are refused, we will follow up with the customer to find a suitable alternative support service.
-We need all of the following information in order to carry out a delivery properly. Once this information has been filled out, we will work to arrange food provision when we can. If the case is urgent, please accompany this form with an email to
Has this person been offered a volunteer shopping service?
Westminster Connects and AgeUK offer volunteer shoppers to residents that cannot access the shops. This service is only for people who cannot afford food. If the person can afford food but cannot access it, please signpost them to suitable service. Thanks
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Does this person work with a support service? If yes, please ask them to contact their support worker for a referral. *
For support workers, please answer "yes" and ensure your details are entered as the referrer. Thank you.
Name of Referrer *
Email of Referrer *
Phone number of Referrer *
For Westminster Connects. Has this person been referred to the CAB? If, No please include the reason why the invitation is being declined as 'other.'
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How many weeks will the customer need deliveries? *
PLEASE NOTE Only people providing direct support to the customer can refer for more than one package. Examples would include social workers, key workers or advisers. If you are not providing direct support, please only refer for one week. If you are not providing direct support, you can refer the same person more than once, but we need a new referral for each week a package is required.
Is this an emergency request? I.e. will this person run out of food in less than 48 hours?
We will attempt to schedule a delivery or collection the next day. However, we cannot guarantee deliveries within that time and are more able to schedule a collection. Deliveries or collections for referrals made on a Friday will be on Tuesday at the earliest. Central London deliveries to W1 post codes take place on Thursdays.
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Does this person have mobility issues that will mean they cannot collect food or they cannot ask a carer or household member to collect? Please specify a reason.
The foodbank has limited capacity to deliver food so can only deliver to households who have no ability to collect. If 'yes' please specify why the customer cannot collect.
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Name of customer *
Customer's post code *
Customer's address *
Please make this as detailed and accurate as possible for the purposes of the drivers delivering food.
Phone Number - Mobile (preferred) *
This will allow us to confirm delivery. Preferably Mobile so we can text.
Phone number - Landline (secondary)
If the customer doesn't have a mobile, please provide a landline number
Access Instructions (Use N/A if none.)
Any information regarding vehicle parking/access that will assist those making the delivery. If upper floors, check if lift/buzzer working.
Number of Adults in the household *
Number of children under 18 in the household *
Ages of children in the household
Dietary requirements (i.e. allergies, Halal etc) *
Does anyone in the household require toiletries (M/F) Nappies (sizes newborn -7), Baby food (phases 1-4) Sanitary products (tampons / pads - light medium, heavy), face mask or incontinence pads (M/F)? Please be as specific as possible. If No - N/A *
NB. Incontinence products are available on prescription but we are able to provide occasional emergency supplies.
Preparatory capacity (items that can/can't be used and ability to prepare and use items.) *
Please check if the customer is able to prepare food from scratch (including tins such as chick peas etc) and has a full kitchen.
Does the food need leaving at the persons front door or do they need assistance getting it into the property? *
At front door will be for people isolating or able to bring their own food into their accommodation. Assistance can be offered for those who are unable to bring their own bags into the accommodation
Does this person need to communicate in a language other than English? *
Is this person likely to have their gas or electric cut off? Only answer ''yes" if the person has a pre-payment meter.
The food bank will contact customers who are at risk of having no fuel to discuss help that can be offered. If the customer does not wish to discuss this wit h the foodbank, answer 'no'
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Is the person self-isolating/shielding?
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Privacy notice
By ticking the box below you (a) consent to having your information used and kept for the purposes of providing food bank services and (b) confirm the following with respect to the customer:

1. The customer understands that their personal data is being collected in order to process an application at the customer's own request
2. For food bank services and for potential on-referral of the customer for other support services; they understand that where consent is provided to NPFB and relevant third parties today for processing their personal data, this is the legal basis on which that personal data will be processed;
3. You have explained to the customer and the customer has given their permission for their details to be shared with NPFB, and, if applicable, with Citizens Advice Bureau and third party service providers appointed to administer the Hardship Grant scheme in keeping with its rules.

This data will be retained for a 2 year period and will be kept in line with data protection laws and guidelines. No private information will be shared with third parties except as above or unless otherwise legally required. Our contact details if you or the customer has questions with regard to data processing: North Paddington Foodbank, Phone Number: 07932 623443 E-mail:
Do you Consent? *
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