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
Home and/or mobile
Data Protection *
I agree that the personal information collected here can be held by The Link Visiting Scheme on computer systems and paper documents as required by the charity for its efficient operation, in accordance with the General Data Protection Regulation 2018. The information you have provided will not be disclosed to any outside organisation. More detail can be found on our policies, and the rights you have regarding your own personal information, on line at www.linkvisiting.org/privacy, or on request directly from the charity by emailing us at admin@linkvisiting.org, or calling on 0118 9798019. If you are happy for us to contact you in future to share general information and news about the charity and keep you informed about events we organise, please tick the box below.