Referral for Support

If you know someone in need of support and want to refer them please complete the form below.

When will they hear back?
One of our team will be in contact with them within 3 working days.

Please be aware that we can only accept applications for people living in Essex.

Who are you referring
Required
Required
Required
What is their address
Required
Required
Required
Required
What are their contact details Please provide at least one method of contact or ideally as many as you can, to make it easy for us to reach you.
(Friend / Family / Next of Kin)
Required
Medical Information
Required
What are you referring them for
Required
Required
Your details
Required
Required
Required
Required

By submitting this form, the information will be sent to the Essex Wellbeing Services team who will contact the referred individual in order to discuss their needs. Certain information may also be shared with a volunteer working in conjunction with the organisation in order for them to provide the requested support to them. We may pass their details onto organisations and individuals who are supporting the community with this programme as well as Essex County Council who commission this service. The information submitted will only be shared where required and to those with a need to know. How we use and share this information is further explained in our privacy policy.

By submitting this form, you confirm that you have informed and/ or sought the permission of the person who you are referring.

In need of some assistance?

If you are in need of some support we have lots of volunteers that are happy to help.

Register for help