Making a referral for yourself

This guide shows you how to fill out the referral form for requesting support for yourself. It will take you through the form step by step.  

Alternatively you can call our Support Team to make a referral on 0808 196 3382^[1]. 

Page last reviewed: 05 June 2024

Select that the support is for me and then select your local authority area. The local authority area determines which support is currently available to you and will be used to match volunteers to the support request based on location. 

Page last reviewed: 05 June 2024

Select the type of support you are requesting from the available options. For details on these support services please see our I’d like support^[2] page for details of available services. Please note not all of the support options are available for self referral.  

When you select the type of support the available activities for this category will be displayed. Select the activity you would like to refer yourself for. Details of the available activities are in the guide below.

Telephone Support

Friendly chats to reduce loneliness and improve wellbeing.

Available activities:

• Check In and Chat Call^[3] - from different volunteers each time
• Companionship Calls^[3] - from the same volunteer (up to 3 calls per week for 6 weeks).

You will then need to enter the reason for the activity support. 

Page last reviewed: 05 June 2024

Telephone Support

Check In and Chat Call

You will need to fill out the following details:

• Frequency - One-off, daily, weekly
  • If one-off also select the Preferred day/date – yes or no and if yes, the preferred day/date – date and time, followed by the number of weeks the support is required for from 1 to 18 weeks. 
  • If daily select which day or days Monday to Sunday, followed by the number of weeks the support is required for from 1 to 18 weeks. 
  • If weekly also select the Preferred day/date – yes or no and if yes, the preferred day/date – date and time, followed by the number of weeks the support is required from 1 to 18 weeks. 

Telephone Support

Companionship Calls

You will need to fill out the following details:

• Preferred day/date - yes or no
  • If yes preferred day/date – select date by clicking on calendar and the time can be selected from the list of available times. Then enter the number of weeks this support is required for from 1 to 6 weeks. 
  • If no, select number of weeks the support is required from 1 to 6 weeks. 

Page last reviewed: 05 June 2024

Enter your details, including an email address if you have one and your preferred language, this is so we can try and match a volunteer with this language to you. Also select your information letter format from the available options. 

Page last reviewed: 05 June 2024

Then you need to enter your GP details. This is so we can contact them if there is a concern such as the volunteer has been unable to make contact with you. 

Page last reviewed: 29 May 2024

Finally complete the consent box and confirm you have read the guidance and eligibility criteria^[4] then register the referral. 

If you need help to complete this form please contact the Support Team on 0808 196 3382^[1].

Page last reviewed: 05 June 2024