Community Connections Befriending Referral Form

Our Befriending Service is currently closed while we seek additional funding to continue supporting our community. Thank you for your understanding.

Community Connections Befriending

*Please continue on this page if you want to refer another person for a Befriender. If you wish to request a Befriender for yourself then please go to this page HERE.

Befriending Referral Criteria (2025)

IMPORTANT – To set expectations and help ensure a successful engagement please read and share the following criteria with the person you are referring before completing the referral form below:

Third party referrers should ensure the person they are referring understands and agrees to the referral. Please fill out the referral form together with them – discuss what they would like to achieve from having a befriender and include this information in the referral form below. Please complete all sections of the referral form with the person being referred, otherwise we may be unable to accept the referral
Our capacity is limited and not designed to cope with complex cognitive or mental health needs or Dementia diagnoses. It is important that the person you are referring knows about alternative options. The following links may be helpful: Dementia services in Lewisham and our CCL Directory
Those who get referred to our Befriending service (the ‘befriendee’) need to be able to form a mutually rewarding and boundaried relationship with a volunteer and be able to make and keep appointments
We are a volunteer-led service so there is likely to be a wait before we can allocate a suitable befriender. We aim to get in touch with accepted referrals within 6 weeks
Our service prioritises those with no alternative sources of companionship, subject to the availability of a suitable volunteer
Befriendees should actively want the service and be aware of what it can realistically do

The person you are referring must:

Be aged 18+
Be a resident of the Borough of Lewisham
Have agreed to the referral
Have expectations and needs that are within our service’s scope and capacity
Be able to answer the phone independently and hold a conversation over the phone
Not have a diagnosis of Dementia or complex mental health support needs.
Not be misusing drugs or alcohol and/or have a history of violence – this is purely to safeguard the welfare of our volunteers.

Please ensure that the person you are referring is aware of what a Befriender can and cannot do:

A Befriender Can...

A Befriender Cannot...

Visit you at home
Contact your GP, Social Worker, or anyone else on your behalf (they will always want to support you to represent yourself and can signpost to other services to help you do that if needed)
Give you medical or financial advice
Provide personal care, cleaning, or shopping services
Give you their personal number to call outside of agreed times
Provide counselling or advocacy
Handle money for you - You should never make any payment to your befriender for their service, give them access to your bank accounts, or have any sort of financial transaction with them

Are you referring yourself or somebody else? *

Please confirm that the person being referred meets the above criteria. *

I declare that I have read the criteria at the top of this form and am referring myself or a person who meets all criteria. This includes not having a dementia diagnosis.

Where did you hear about CCB? *

i.e Community Connections Lewisham, leaflets, community event

Apart from this Befriending service referral, have you also referred to Community Connections Lewisham for social prescribing support, or do you plan to do so? *

Please follow this link to refer to Community Connections Lewisham - https://communityconnectionslewisham.org/make-a-referral/ - Please note: if you plan to, or have already referred to CCL for social prescribing, we may not accept this application, as social prescribing should be sought in the first instance when appropriate. Befriending can be accessed later via their pathway if needed.

About you, the befriendee

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Telephone Number *

Date of Birth *

Gender *

Ethnicity *

Please select one from the dropdown list above

If you selected 'Other' for your ethnicity please tell us your ethnicity here

Which of the following best represents your sexual orientation? *

Please select from the dropdown list above

Do you consider yourself to have a disability? *

Is there anything you'd like us to be aware of, such as health conditions, access needs, or support requirements?

How frequently would you be comfortable being contacted? *

Weekly
Fortnightly
Monthly

What would you say to introduce yourself to a potential befriender?

If you are making this referral on behalf of someone else, please ask this question directly to the person you are referring, and record their response in their own words. Answers such as 'ask the client' will not be accepted.

Is there a goal you would like to work toward with a befriender? *

What interests would you like to share with a befriender? *

Is there anything else we should know about you to match you with someone? *

CONSENT - I consent to Community Connections Lewisham (Age UK Lewisham and Southwark) recording personal and sensitive information about me: * *

In order to help you, we need to store information about you. The law says that we must get your consent to do this. Everything you tell us will be treated confidentially and your data will be subject to the Data Protection Act 2018. Records will be kept securely for 6 years and then securely destroyed. For more information please visit our website at http://www.communityconnectionslewisham.org

[DO NOT USE] Office Use Only

Our Befriending Service is currently closed while we seek additional funding to continue supporting our community. Thank you for your understanding.