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About
How it Works
Services
FAQs
Referrals

Online Referral Form

This form is intended for both family members who wish to refer a loved one and for professionals from hospitals, GP surgeries, social services and charities who wish to refer someone to Tea & Company for companionship support.

We aim to respond to all referrals within 48 hours. If urgent, please also call us on

07360 004279.

Referrer Details

Full Name*

Please indicate who the referral is for

Myself

A Family Member

Organisation submitting a referral

Position

Phone*

Referrer's Email*

Client Details

Clients full name*

Date of Birth*

Client's address

Country/Region*

Address*

City*

Zip / Postal code*

Client's Phone*

Client's email*

Reason for Referral

reason for referral*

Loneliness/isolation

Recently discharged from hospital

Carer respite needed

Limited mobility/socially isolated

General companionship support

Other

Support Required

Support required*

Regular home visits

Community outings (shopping, cafes, walks)

Carer respite needed

One-off visit

Other

Urgency

Standard (within 7 days)

Urgent (within 48hrs)

Additional Information

Consent

I confirm the client has given consent for their details to be shared with Tea & Company for the purpose of companionship services

Tea & Company - Companionship for elderly adults in Manchester

07360 004279

info@teaandcompanyservices.co.uk

Bookings available throughout these areas:

Trafford, Stretford, Chorlton, Urmston, Sale, Altrincham & nearby - Manchester

Get in Touch

First name*

Last name*

Postcode*

Phone

Email*

Write a message*

Call: 07360 004279

Ready to Chat?

>> Not a Personal Care Service <<

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