Community Connections Transport is able to provide door-door transport to appointments for Lewisham residents. This service is £10 for a return journey within Lewisham, and £15 plus additional expenses (i.e Congestion Charge) if the destination is outside of Lewisham. If there are multiple people going to the same destination we may match more than one person to each vehicle.

We ask that you read the below points before requesting a journey, and if you have any other questions please contact transport@ageuklands.org.uk for more information.

Our drivers will: 

Call you before the drive to confirm, and only contact you about journeys 

Pick you up on time as much as traffic allows it and be positive and helpful towards you 

Drive you safely to ensure you reach your destination with a smile on your face 

Our drivers won’t: 

Drop you anywhere other than the allocated time and route, as we must respect our drivers’ time and other commitments 

Be able to help you transfer into the car

Take payment for the trip: all trips need to be paid in advance over the phone with our transport coordinator 

Go shopping for you or do anything else on your behalf: they are helping you to get to places so you can do things yourself 

We need: 

You or someone you trust to be able to answer the phone to arrange journeys and make payment before the drive 

You to give us 5 working days’ notice for booking a journey 

You to let us know if you need to cancel as soon as possible, we cannot refund if you cancel less than 24 hours before a drive

You to let us know any mobility or language needs that you have so we can best support you 

You to respect the driver, other passengers and the vehicle you are in at all times

Please only refer if you have a specific journey you would like to request.

If you would like to log a general interest, please contact Angelie on 07927 953 487 or transport@ageuklands.org.uk. If you add a date simply to fill in the form then your referral will not be processed.

What kind of journey are you requesting? *SocialHealthcareShoppingEducationOther

What service are you requesting?Travel CompanionCommunity Transport

Travel Companions support those who are independent enough to use public transport but need support with following a route or who want someone to come with them on the way. Transport drivers take up to 3 people in a vehicle to destinations who otherwise cannot use public transport but are still able to transfer into a vehicle.

Are you referring yourself or somebody else? *MyselfSomebody else

Where did you hear about CCT? *

i.e Community Connections Lewisham, Leaflet, word of mouth, 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 passenger

Are you an existing Community Connections Transport service user?YesNo

Please note that those who used the service before the transfer from VSL in August 2022 will need to re-register with CCT

Your 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

Do you consider yourself to be disabled? *YesNoPrefer not to say

Please explain what barriers you have to using public transport *

i.e you cannot mobilise without crutches and do not feel confident waiting at a bus stop, you are unable to follow a planned route, you have visual impairments so are unable to identify a route

Do you use... *

• a walking frame
• crutches
• a wheelchair (must be foldable)
• none of the above

Please know that we are unable to support service users who cannot transfer themselves into a vehicle

What access is there to your front door?

ie up stairs, round the side of the building, live on the 3rd floor, buzzer doesn't work

Do you receive any form of benefits? *YesNoPrefer not to say

Please specify which benefits

Preferred method of contact *PhoneEmailText messageLetter

Are you or your next of kin able to pay by card upfront for their journey? *YesNo

This can be done over the phone or through a link sent to their email

If not, how are you able to pay?

• Invoice
• Cash

Please give more detail about the problems with paying upfront *

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.

About the Journey

Name of activity

i.e Sow & Grow, Blood Test, PIP Assessment, Pottery Class

Where do you want to go? *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

United KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountry

Is this a regular trip or a one-off? *RegularOne-off

When do you want to arrive? *

Date

Time

Please note that we need at least 5 working days' notice to fulfil requests

How long will you be at the destination? *

When do you want to be picked up? *

Date

Time

Please give more details of future journeys

e.g every second Thursday at 2pm, Mondays at 9am for three weeks ending 7th July, every Tuesday

Is there any other information about the journey we should know?

eg you will have a dog so can't be in a car with anyone else, you will be carrying shopping, you don't know when you will be done

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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