Referral Form

Our 1:1 visiting service is designed for older people who live in Wokingham Borough and who experience loneliness and social isolation. We give priority to those living alone.  We accept referrals for those who live independently or in sheltered accommodation and lack a strong social network. They must be capable of forming friendships and not have complex needs. We are not able to accept those with a Personal Care Budget that covers social inclusion. If we are unable to help, we will try to sign-post to an organisation that can. Please contact us for our full referral policy.

This form should take a roughly 10 minutes to complete. 

Section 1 - Basic Information
Service requested (tick)
Name *
Name
dd/mm/yyyy
Including town and postcode
Home and/or mobile
Section 2 - Other Information
Has there been a diagnosis?
Section 3 - Person Referring