Request a Visit

If you or someone you care for is unwell and would welcome a visit, let us know and we will try to arrange one. You can fill this in on someone else's behalf.

Name of the person to be visited (required)

Your name (required)If you are filling this in for someone else, put your own name here.

Your relationship to them

Contact phone number (required)The best number to reach you on to arrange the visit.

Contact email

Where are they staying? (required)

Name of the hospital or institutionLeave blank if they are at home.

Ward, room or unitIf known — it helps the visitor find them.

Town or area (required)So we can match someone nearby.

Would you prefer the visitor to be…

No preferenceA male visitorA female visitor

Languages they are most comfortable in

Best times to visit

Anything the visitor should knowOnly what is helpful for the visit itself — mobility needs, whether they tire easily, anything to avoid. Please do not include medical details you would not want shared with a volunteer.

I confirm the person named consents to being contacted about a visit, or that I am able to give that consent on their behalf. (required)