Befriending Service Referral Form 
***NOTICE: We are a small, part-time team - please help us save time by reading the Befriending Service overview before submitting a referral, and wait at least a month before contacting us about a referral***

Currently we offer a 12 week face-to-face befriending service for those aged 65 and over who live alone in the Glasgow City Council and do not have a diagnosis that requires specialist support, such as dementia. For people with dementia, Alzheimers UK run a Befriending service: helpline@alzscot.org / 0808 808 3000

Read our Befriending Service overview here.

All information provided here will be treated in line with our GDPR policy. It will be made
available to The No.1 Befriending Agency staff for the purposes of assessing suitability for our services and, if accepted to receive our services, with registered volunteer befrienders for the purposes of providing a befriending service.
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Email *
Service user's full name *
If the service user prefers to go by another name, what is it?
Service user's date of birth 
MM
/
DD
/
YYYY
Service user's full address *
Postcode *
Service user's phone number
Next of kin name
Next of kin relationship to the service user
Next of kin's phone number
Referrer name (if filling out the form for yourself, just write self-referral)
Referrer organisation
Referrer's phone number
Referrer's email address
We can keep referrers up to date with our progress if the service user gives permission. If you’d like to receive a progress report, please indicate below. *
Who should No. 1 Befriending contact to arrange the initial assessment? *
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