Your Details

Your Email (required)

First Name (required)

Last Name (required)

Your Telephone Number (required)

If you are referring in a professional capacity, please tell us your organisation and job title (optional)

How does the referrer know the older neighbour?

Older Neighbours Details

We are able to support people aged 65+, living alone that do not need specialist care support.

First Name (required)

Middle name(s)

Last Name (required)

Preferred Name (optional)

Gender (required)
Male Female Other

Address Line 1 (required)

Address Line 2

Address Line 3

Town (required)

Postcode (required)

Date of Birth (required)

We are only able to accept referrals for 1:1 befriending for those aged 65 and over.

Emergency Contact Number (required)

Phone Number (required)

Reason for referral (required) Please add in as much information as possible e.g. details of sensory impairments, mobility issues, health issues, type of property

Protecting our volunteers:
Note that all volunteers are ordinary members of the public with no medical or social care training. Are you aware of any information that could put our volunteers at risk?

Any other relevant information?

If this person has a Carer, please enter the name and contact number of the Company

Please note that we are unable to support older neighbours with a health diagnosis that would require specialist care (e.g. those living with dementia or severe mental health difficulty)

What language does the older neighbour communicate in? Please note that most of our volunteers speak English, however, we will do all we can to accommodate any other language requirements.

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

You can review our Data Protection & Privacy Policy here

We are unable to accept this referral - please see our criteria list at the top of this page.