Apply For A Befriender

Who we support

This form can be filled out by anyone wishing to find a Befriender either for themselves or someone they know.

We support:

  • people aged 65+
  • living alone in the Borough of Surrey Heath
  • who are experiencing loneliness due to limited social connections
  • who have consented to the referral

Those with no alternative sources of regular companionship are prioritised, along with those who feel socially isolated and lonely due to frailty or physical impairments, which prevent them from leaving their homes.

We would love to be able to accept all people referred to our service. However, we are not equipped to work with those who:

  • have challenging behaviours.
  • drug or alcohol addiction.
  • require personal care.
  • are residing in a home that is unclean or unsafe.
  • are living with dementia or have other complex mental health needs.

Sometimes people have support needs that are not suitable for this scheme, perhaps because they are too complex, or the needs are not linked to being lonely and isolated.

We want to ensure that each person receives the best support.  We may signpost you to another organisation where they have specific programmes and support on offer.

Got Questions?

Please get in touch

Apply for a Befriender today!

Information about the person being referred:

First Name
Last Name
Address
Telephone
Email
D.O.B.
Marital Status
Marital Status
Marital Status
Emergency Contact Name
Emergency Contact Telephone
Medical History Please include any information relating to substance use, mental health, and cognitive impairment.
limited mobility
Communication difficulties
cognitive difficulties
loneliness and isolation
Referrer Name
Referrer Telephone
Referrer Email