Make a referral for a relative

If you are making a referral to ALONE on behalf of someone else, please make sure you have the person’s consent to do so.

If possible, complete this referral form in the company of the person being referred.

To find out more about making a referral to ALONE services, please click here
ALONE Logo New

Referral from a Relative

I would like to refer a Relative
Please fill out your own details here: 
Consent:
In order to process the referral, you must confirm that consent has been received from the older person and the date that it was received:
Please read ALONE's privacy statement
Key Information about the Older Person:
Please use the key information section below to fill in the information about the person you are referring.
Please note that the person should be over 60+. Date format DD/MM/YYYY
The area where the person lives such as Kilmainham, Dundalk, Kilkenny City, Buncrana.
To find the EIRCODE, please visit EIRCODE FINDER
Please include name, contact details and relationship.
Please provide some additional information about this referral:
What is are the main reasons ALONE's support is needed? Is it loneliness, physical health, dementia, mental health, housing difficulties, or other?

Contact Information

dot

Publications & Resources

+ Do You work with older people?

dot

Follow us on Facebook

ALONE-facebook-02

Follow us on Twitter

ALONE-twitter-02

Follow us on Instagram

Instagram