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This form is for you to refer yourself, a family member, a friend or your client/patient to Age UK Lindsey's Services. In order to process the referral, Age UK Lindsey must collect personal data about you and/or your client/family member. For information about how your details are used and stored by Age UK Lindsey, please click here to read our privacy notice. 

If you are referring on behalf of someone else, please ensure that you have received their permission to do so, before submitting their data, and that you complete your details in the relevant section.

Coronavirus update:

All of our services have been adapted to continue providing support throughout the pandemic. There may occasionally be a short delay in responding to your enquiry due to changes in staffing and operating practices, but we will be in touch as soon as possible.

Thank you for your understanding

Service Referral Form


Who is being referred to Age UK Lindsey?

Please tell us more about the person being referred to Age UK Lindsey.  This could be yourself, a family member, friend or your client/patient.

Are you...?

If you are completing this form on behalf of yourself, we now have all the personal details that we need in order to start the referral process.  Please scroll down to the bottom of the page, confirm that you have read the privacy notice and then click submit.  If you could also let us know how you heard about Age UK Lindsey, that will help us to reach and support more older people.


Referrer's Details

If you are completing this form on behalf of someone else (e.g. a family member, client or patient), please complete the following section.  Otherwise, please scroll down to the bottom of the page, confirm that you have read the privacy notice and then click submit.

General Data Protection Laws (GDPR) dictate that consent must be obtained for a referral to be accepted and recorded.  Please confirm that your client/patient/family member/friend has agreed to:

The referral being made to Age UK Lindsey
Being contacted directly by Age UK Lindsey
Age UK Lindsey storing their information