Client enquiry

Tell us how we can help

Complete this form for yourself or on behalf of a family member. It helps us understand the kind of companionship and practical support that may be useful.

About the person needing support

Full name Preferred name Postcode Home address

Your details

If you are completing this form for someone else, please tell us how you are connected.

Your name Relationship to client Email Phone

What support would be helpful?

Companionship & conversation Shopping & errands Accompanied appointments Social outings / cafés / activities Light meal preparation Letters, forms & life admin Phone / tablet / video call help Something else

Please tell us more

Preferred days and times

Preferred time Approx. hours per week

Transport & mobility

Would transport be useful? Would any accessibility arrangements be helpful? Any practical access information we should know? Please avoid including diagnoses or detailed medical information here; we can discuss anything sensitive by phone.

Important information

Northern Fells Companions currently provides non-regulated companionship and practical support only. We do not provide personal care such as washing, dressing, toileting or hands-on support with eating.

Is there anything else you would like us to know?

Your information will be handled in accordance with our Privacy Notice.