Request a caring caller

To request a caring caller for yourself or someone else, please complete the form below.

Holiday Closure Notice

Please note that the Caring Caller service will be closed from 19 December to 12 January. Referrals can still be submitted during this time; however, there may be a delay in our response until the service reopens.

We appreciate you’re understanding and look forward to reconnecting in the New Year.

Please Select

Please select from the following options:

I'd like to refer a person to the Caring Caller service

I'd like to receive a regular call from a Caring Caller

I'd like more information about the Caring Caller service

YOUR DETAILS

First Name

Last Name

Your Phone Number

Your Email

If you do not have an email, please phone 0800 4 CALLER (0800 422 5537)

Job Title

Organisation

Does the person you are referring know about this referral

Yes

DETAILS OF THE PERSON BEING REFERRED

Their First Name

Their Last Name

Their Phone Number

Their Email Address

THEIR ADDRESS DETAILS

Address

Address Line 2

Address Line 3

Address Line 4

Address Line 5

Suburb

Town / City

Postcode

Post code finder

THEIR OTHER DETAILS

Other Languages

Please provide further details about the person you're referring if appropriate

Comment

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