Make a referral for yourself

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

ALONE Self Referral Form

Key Information:
please note that ALONE is a charity that supports people aged 60+
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.
How can ALONE support? 

Please note:
When you press the submit button below you will see a summary of your form.

You must press the confirm button on the summary page for the referral to be completed. 

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