Warm and Well Referral Form

Support and advice is available to the over 60s in Haringey to keep warm and well this winter. Use this form to request help from our team.

Your details

Name *

Phone number *

Date of birth *

dd/mm/yyyy

Address *

Postcode *

Email address

What support do you need?

select all applicable options

Help to stay independent at home (enablement)

Care and repair / winter handyperson offer

Advice on keeping warm

Advice on benefits

Advice on using the internet

Fire Brigade checks (including fitting of fire alarms and carbon monoxide detectors)

Additional information

Is there anything else you would like to tell us?

Details