Compassionate Neighbours Referral Form

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Compassionate Neighbours is free, community-led support for anyone who is lonely and/or socially isolated and is nearing the end of life through age or illness.  It is delivered by Garden House Hospice Care in North Herts.

Following referral, the person will be contacted and visited to assess their suitability and needs.  If they consent to receiving support from a Compassionate Neighbour, we will then seek to match them with a trained and supported person who will visit them regularly.
Referrer Details


If your Organisation is not mentioned on this list, then please select "Other" and specify the name of your organisation




No spaces allowed



eg. Self Referral, Friend, Family Member
Details of the person who would like support



No spaces allowed

No spaces allowed


Enter date as DD/MM/YYYY or use the calendar




Please enter postcode with a space (eg SG6 1QU)

Permission/Consent




Additional Details









Next of Kin details




No spaces allowed


Enter date as DD/MM/YYYY or use the calendar
Please Note:
The Referee will only be notified should a suitable match be unsuccessful or the person does not meet our criteria.

Thank you for your referral.  If there is anything else you would like to discuss, please contact the Compassionate Neighbours Team.