Refer someone or get support for yourself

Who is the support for?

MeA family memberA friend or neighbourSomeone I support through my work

Your details

First name (required)

Last name (required)

Email address (required)

We'll use this to confirm we have your form.

Telephone number (required)

We'll treat this as a UK number (+44) unless it starts with a different code, for example +353.

Organisation

Your role

About the person you are referring

Their first name (required)

How do you know them?

For example, my mum, my neighbour, a client.

Their telephone number

We'll treat this as a UK number (+44) unless it starts with a different code, for example +353.

Town or area where they live

They know about this referral and are happy for us to contact them. (required)

If you have not talked to them yet, please do that first, or call us and we can talk it through.

What might help

Tick anything that sounds useful. It is fine not to be sure yet.

What do they (or you) enjoy talking about?

Hobbies, places, music, family. It helps us make a good match.

Best days and times for a call

Anything else you would like us to know?

Please do not include medical details here. We can talk about any needs when we speak.

Your agreement

I agree that A Digital Friends can store and use the details in this form to reply to me, as described in the privacy policy. (required)

Prefer to talk? 07443 375387

Tell us who would enjoy a friendly call