Good Neighbour Self-Referral Form

Good Neighbour Self-Referral Form

Thank you for contacting Good Neighbours. Please use the form below to tell us about the support that you need for yourself*.

*If you would like to request support for someone else e.g. a client, friend or family member, please complete this form.

Please note that in order to use the Good Neighbours service then the person that is in need of support must be:

  • A Warrington resident
  • Unable to carry out activities independently due to health, age, disability or other barriers
  • Have no-one else in their support network that can assist

To learn about the support we offer click here.

Please ensure you have submitted as much information as possible, otherwise the referral will be sent back to you and the support request will be delayed.

I give my consent for my personal information to be shared with volunteers and other relevant support organisations for the sole purpose of assisting with my specific requests for help/support from the Good Neighbour Project
Your Details
This project is only available to residents of Warrington.
Please provide name, relationship and phone number.
Support Requested
There may be other one-off tasks the Good Neighbour project may be able to help with. Select a maximum of 3 PLEASE NOTE: This is for individuals who are socially isolated and with no-one else who you/they can rely on for support (and tasks you/they are unable to perform themselves).
We may prioritise requests from people who identify as being isolated and living alone.
This is asked to ensure we can match with an appropriate volunteer.
This is asked as we are a befriending service, our volunteers are not trained to give mental health advice.
This is asked as we are a befriending service, our volunteers are not trained to give mental health advice.
This includes and hearing problems, mobility issues and anything which could affect your befriending. Feel free to include any interests or hobbies in here too and we might be able to find a volunteer who has similar interests. *PLEASE NOTE we are unable to provide in person support to wheelchair users
Shopping Details

PLEASE NOTE: Our shopping requests are done by volunteers, therefore we can not guarantee when the shopping will be delivered as it is dependent on volunteer availability. WE DO NOT TAKE SHOPPING REQUESTS ON FRIDAYS, they will be picked up the following week.

We have a set shopping list of:

Milk, Bread, Eggs, Butter, Ready meals, Fruit and Tea bags. 

If any additional items are required (such as toiletries or drinks) they need to be put in the additional items box to be added to the list and if there are any allergies or intolerances they must be stated where asked. 

The Gateway, 89 Sankey Street, Warrington, WA1 1SR Tel: 01925 246880
Registered in England & Wales as a Registered Charity 1129343
and as Company Limited by Guarantee No:6805818

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