st clares logo
24 hour advice
phone line:
0191 529 7108

Befriending Service referral

If you need any help using our online referral system, please call the Referrals Team on
0191 529 7100

This page is for healthcare professionals to make patient referrals. The quickest and easiest way to make a referral is to use our online referral forms. However, if you would prefer to print off a form and send it to us by post or fax, you can download them using the links on each service listing below.

Online referral form

About the person you are referring

Permission to inform the next of kin of the process?

Yes No

Does the person live alone?

Yes No

Would you be aware of any risks to a befriender caused by?

Unsafe access
Unsafe environment

Does the person use walking aids?

Stick
Frame
Wheelchair
Bed bound

About the agencies / contacts currently involved (please tick where appropriate)

Community Matron
District Nurse
Social Worker
Home Carer
C.P.N
Family
Meals on Wheels
Dare Care Attendance
Friends
Neighbours
Specialist Nurse

Referrer details:

This referral cannot be made without prior consultation with the service user.

Has consultation taken place

Yes No