I&A referral form

Please provide details in the form below and one of our advisors will be in contact.

When making a referral please ensure you give the name and details of the person you are referring and the same details of their carer, so we can arrange all appropriate support. 

Our current waiting list is approx. 1 week for general enquires, 3 weeks for a benefit check. Please let us know if your enquiry is urgent and we will aim to respond within 2 working days (in the referral reason or email us after you submit your enquiry). 

If you are asking to check someone's benefits eligibility, please ask them to have information about their health, income, capital/savings, rent/ground rent/service charges if they pay any, council tax and energy provider ready for the call.

By submitting this form you are giving your consent to Age UK Hertfordshire to hold your data. The information you provide will be held in electronic and paper record formats, in a confidential and secure place in accordance with the General Data Protection Regulation. Your information will only be shared with our partners and used for the purposes of providing the services you have requested. For more information on our partners please refer to our Privacy Notice Age UK Hertfordshire | Privacy Notice