Befriending service self-referral form

Full name(Required)

Preferred name

Age

Telephone number(Required)

Email address(Required)

What are your hopes for befriending? (what do you want to get from befriending?)(Required)

How do you spend your time?(Required)

(Do you have any regular commitments e.g. caring responsibilities, volunteering or work?)

Do you have any hobbies or interests, or any you would like to explore?(Required)

About your availability & preferences for befriending:

Befriending takes place for up to 12 sessions. Calls take place between Monday - Thursday 9am to 5pm lasting up to 30 minutes per session. Where possible befriending calls will take place at the same day and time each week.

When would be the best time for your befriending calls?(Required)

All Bramber Bakehouse volunteers are female. Do you have any preferences about the person you are matched with? If so, please tell us your reasons.

Is there anything else you would like to tell us about you that is relevant to your befriending referral, including any barriers or concerns around accessing the service.

Monitoring & Evaluation

To measure the impact of Bramber Bakehouse's befriending service, we request that you answer the 3 questions below at the beginning and at the end of befriending support.

When answering the following 3 questions, please take account of the following:

There are no right or wrong answers
We would like you to be completely honest
In answering the questions it is best to think of your life as it generally is now (we all have some good or bad days)

How will you use my data

Name

Signed

Date