Referrals can be made for people who are over 65 by professional organisations involved in social care, for example, your GP, the NHS, adult social services etc.

If you would like to refer yourself or a family member and you are in Northumberland, the NHS support planners can arrange your referral.  Otherwise please just contact our home visiting team on 01434 505220 who will be happy to help.

Before competing the referral form please ensure you have all the information in full including the risk assessment.   Partial submissions can't be accepted.

If you are 65 or over, can no longer have a dog of your own and would like to arrange a visit for yourself or for a member of your family please do not complete the form, instead contact us for advice on 01434 505022.

Referral Made By

Emergency Contact

Visitee Details