Befriending Scheme Referral Form - Confidential

Referred Person:-
This project is specifically for people who are socially isolated because of their mental health issues and uses trained volunteers as one to one Befrienders.
If the person you are considering referring to this scheme presents a risk to the Befriender, they would not be suitable for the service.
This form is intended to be completed jointly with the person who wishes to have a Befriender.
This is a required field
Referring Agency:-
This is a required field
This is a required field
Additional Information
Mental Health:-
This form will be sent to the Befriending Scheme Co-ordinator when you click on the Submit button.
General Information:-
Please give a brief history of the following, where known and appropriate.