Service Referral Form
This form is for you to refer yourself, a family member, a friend, or your client/patient to The Loneliness Prevention Project. In order to process the referral, AFC Fylde Community Foundation must collect personal data about you and/or your client/family member. For information about how your details are used, and stored, please to read our privacy notice.
If you are referring on behalf of someone else, please ensure that you have received their permission to do so, before submitting their data, and that you include your details in the relevant section.