Refer Someone

Refer Someone

Do you know of someone that could benefit from any of our services?

Referring someone you think may benefit from the services we provide is a step in the direct direction for the person and for our community as a whole. Most importantly, you are giving another act of kindness, because YOU CARE

Referral Form

Disclaimers

Unfortunately we cannot accept this referral as the law require us to have the permission of the person before we can contact them. Please do get the authorization of this person in order for you to make the referral.

Thank you for being part of our vision.

You are a star!

Please note that without your permission, we cannot contact you. Since you are doing this wonderful gesture to support us in our quest to reduce the impact of loneliness and isolation, it is important that we have your permission. Your permission is only to contact you in a case where we are unable to contact the person you have referred and we need to contact you to confirm their details.

Thank you so much for being part of your journey to reduce the impact of loneliness and social isolation

Your Details

Details of the person you wish to refer

Any disabilities

Complete below form please

Other Information

Please be aware, that without this authorization, we will not be able to accept this referral. Thank you

Sorry we cannot complete your self referral as you have not authorised us to contact you to discuss your referral. If you still which to go ahead with this self referral, kindly review your choice by clicking on ‘Yes’ for the last questions asked. Thank you