Tackling Social Isolation

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Referral into Fleetwood Town Community Trust's Tackling Social Isolation project aiming to support adults at risk of loneliness and isolation

Name *

Email *

Is the participant isolated and/or alone *

Yes

Required

Name of participant *

Date of birth *

YYYY

Address and postcode of participant *

Email address of participant *

Phone number of participant *

Name of person completing this form (if not the participant) *

Has the person been made aware of the referral *

Yes

Required

Phone number of person completing this form (if not the participant) *

Which activity would the participant be interested in being involved in (may select more than one option) *

Phone calls - Friendly chat around topics of interest

Garden gate visit - Regular social distanced visit to chat and offer support

Weekly online coffee morning - online quizzes, conversation, offer support where needed

Individual walk and talk session - an easy walk with a member of our staff

Required

Submit

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