Make a Referral

Complete the form to refer an Older Neighbour if they meet the referral criteria for a b:friend volunteer.

Aged 65 and over
Living on their own
Living in a safe and clean home, free of clutter and hazards
We are unable to support people with specialist care needs
(e.g. dementia, learning disabilities or severe mental health difficulties)

(We may contact you if we need more information about this person.)

Our DBS-checked befriender volunteers visit older neighbours once a week for an hour for a natter and a cuppa.

✅ What our befrienders can help with:

Friendly company and conversation in the older neighbour’s home, or over the phone
Having a nice cuppa and a laugh
Making a new connection in the community through friendship

❌ What our befrienders can’t help with:

Any personal care or practical support, such as:

Carework
Cleaning, gardening or DIY
Shopping
Handling people’s personal or financial affairs
Handling medication
Taking people out or giving lifts to the shops, to medical appointments

Your Details

First Name

Last Name

Email

Phone

Organisation / Job Title (optional)

How do you know the older neighbour?

Older Neighbour's Details

First Name

Middle Name(s)

Last Name

Preferred Name

Gender

Date of Birth (dd/mm/yyyy)

Address Line 1

Address Line 2

Address Line 3

Town

Postcode

Phone

Emergency Contact

Language

Carer Company & Contact

Reason for Referral

Any Other Relevant Info

Medical Details

Do they have pets?

Do they smoke?

Do they live alone?

Do they have dementia?

Is the home suitable for a volunteer (clean/safe)?

Has this person been declined from services before?

Yes

No

I don't know

Do they have any previous convictions?

Yes

No

I don't know

Do they have any addictions?

Yes

No

I don't know

Interested in attending a Social Club?

Yes

No

I don't know

Can the neighbour drive?

Yes

No

I don't know

Can they access public transport?

Yes

No

I don't know

Equity, Diversity and Inclusivity Monitoring

Please note that this data is anonymised and is for monitoring purposes only.

Why do you need this information? b:friend is committed to promoting equality and diversity at every level. We collect this data to ensure our charity operates in a fair, equitable and inclusive way. We use it to provide information to our funders about the communities we support and work with. The data also helps us identify potential barriers to access and participation and to improve our services.

How would you describe yourself? (required)
Please note this data is anonymised.

Please specify

Do you have a disability, impairment or health condition which affects your day-to-day activities? (required)

Which of the following options best describes your sexual orientation? (required)
Please note this data is anonymised.

Please say how

What is your religion or belief? (required)
Please note this data is anonymised.

Please describe

I have express consent from the above person to share their details with b:friend.

You can review our Data Protection & Privacy Policy here