Make a Referral

Agewell delivers a range of services for people aged 50 and over. We accept referrals from GPs and health professionals as well as friends, family members or neighbours. You can also self-refer.

If you are referring someone other than yourself, we do require confirmation that you have obtained consent from the person themselves for us to contact them, before we are able to get in touch.

Fill in the online referral form below, download the PDF and fax back or contact us here.

Interpreter Needed

Disability

*Confirmation of consent to share information with Agewell

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Security

All data submitted to Agewell is encrypted with industry leading security.

Data Protection Privacy Notice

Agewell CIC will only collect and use your information for the lawful purposes of administering our services. Your data will be collected for monitoring purposes so that we can track you through our system in order to confirm that youhave accessed the service and for general monitoring and evaluation purposes.

We will also use this information to support and monitor our commissioned services to enable the continuation of Agewell services. This data will be stored on Agewell’s electronic systems and will be shared with commissioners. Your information will remain on this system for a maximum of 3 years. Any further use of your data will be either replaced with a code or anonymised, so that we cannot identify any individual.