Health & Wellbeing Service Referral Form

The Health and Wellbeing service is provided by volunteers who work with clients to improve physical and emotional health, wellbeing and independence. The emphasis is on a partnership, with the volunteer and client working together to set and achieve goals. Use this form to check whether the person is suitable for the Health and Wellbeing service and to make a referral. This form covers four areas: 1. Criteria required for client to be accepted 2. Exclusion criteria; needs which cannot be met by this service 3. Client and referral details 4. Your details as the referrer Fields marked with an * are required