Talk 2 NICE Referral Form
Talk 2 NICE, is a free friendly check-in service specializing in the care of elders and disabled community members.
All people are welcome to reach out for support.
Our goals are to offer free ongoing, over the phone, friendly outreach and brief counselling services to socially isolated and lonely community members through brief friendly check in calls.
We strive to respond to all referrals between 24 and 48 hours.
Please note, this is not a crisis service. If this is an emergency please contact 911.
If you require crisis support please contact, Toronto Distress Centres: 416 408-4357 or 408-HELP.
Name of Person Completing this Form
Name of Person Being Referred
Their primary phone number
Their email (if available)
Their City and Province
Does this person have access to any or all of the following
Laptop or Computer
Does this person have access to internet
Emergency Contact (Name)
Emergency Contact (Phone Number)
Emergency Contact Relationship to Client
Formal Caregiver/ Staff
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This form was created inside of Toronto Home Share.