What can you expect from Community Connections Befriending? 

To be matched with a friendly volunteer who will contact/visit you regularly

A regular positive phone conversation or visit from a volunteer 

Encouragement and information to engage with your community 

A befriender can: 

Have a regular, friendly chat with you about your interests and hobbies  

Support you to get more involved in the community 

Motivate you to be more active by walking in the park or round the block for example

Go to a local café with you 

A befriender can’t: 

Support people with a Dementia diagnosis as they are not trained to be able to provide the right support

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 that can help you to do that if needed. Our volunteers can’t give you medical or financial advice. 

Provide personal care, cleaning or shopping services 

Can’t physically support you (eg push a wheelchair, support you walking) 

Give you their personal number to call outside of agreed times 

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 

What do we need from you? 

We need you to be able to answer the phone to arrange contact, and let us know when you are unable to speak to your befriender 

We need you to let us know when you no longer need the befriending service so our volunteer can be matched with someone else  

We need you to let us know if things aren’t going as you were expecting with your befriender 

If you have any concerns or complaints regarding your befriending relationship, or any compliments or feedback, or are interested in being a part of our service user steering group, please contact Sandra Monday – Friday on 07934 554 601 or befriending@ageuklands.org.uk 

Are you referring yourself or somebody else? *MyselfSomebody else

Where did you hear about CCB? *

i.e Community Connections Lewisham, leaflets, community event

About the referrer

Referrer's name *

First

Last

Referrer's organisation *

Referrer's email *

Referrer's contact number

Referrer's relationship to service user

About the befriendee

Name *

First

Last

Gender *WomanManNon-binaryPrefer not to say

Date of Birth *

Ethnicity *Unknown/Not stated ArabAsian or Asian British - BangladeshiAsian or Asian British - ChineseAsian or Asian British - IndianAsian or Asian British - PakistaniAsian or Asian British - Other Asian backgroundBlack or Black British - AfricanBlack or Black British - CaribbeanBlack or Black British - Other Black backgroundLatin AmericanMixed - White and AsianMixed - White and Black AfricanMixed - White and Black CaribbeanMixed - Any other Mixed backgroundWhite - BritishWhite - Other White backgroundIrishRoma Gypsy or Traveller of Irish HeritageOther - Any other Ethnic groupPrefer not to say

Please select one from the dropdown list above

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Telephone Number *

Email

How would you like to be contacted by a befriender? *

• Telephone
• In-Person

How frequently would you be comfortable being contacted? *

• Weekly
• Monthly
• Other

Please explain 'other'

What goal would you 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? *

Next of Kin details

If you prefer, we can make contact with your Next of Kin (family member or close friend), provided they have given their permission.

If so, please provide their full name, contact details and their relationship to you in the box below.

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

• YES
• NO

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

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