Easy Steps to Request Bereavement Support / Make a Referral

Our trained bereavement support volunteers are located throughout North Wales and we do our best to match clients needs as closely and as quickly as possible. To help us do this please download and complete the appropriate form or forms below.

WHICH FORMS SHOULD I DOWNLOAD?

Self Referral (Adult)

Download this form if you are making a referral on your own behalf. Click here


Third Party Referral (Adult)

Download this form if you are doing this on behalf of someone else who is an adult.  Click here.


Parent or Third Party Referral for a Child/Young Person

Download this form to submit a referral for a child or young person. Click here

PLEASE NOTE: You will also need to complete and send in a signed parent/guardian consent form. Click here


CAN I COMPLETE THE FORM(S) ELECTRONICALLY?
All the forms for Adults* and Child/Young Person are designed so you can complete them electronically or alternatively you can print the form and then fill it in.
* Using Acrobat or a compatible pdf reader - available to download, Click here
Please note Cruse Bereavement North Wales is not responsible for the content of any external sites.

HOW SHOULD I RETURN THE COMPLETED FORM(S)?
By Email: Electronically completed forms should be saved then emailed back to us (see email address on the form). – Printed forms can also be returned this way if scanned once completed, but not the Child Consent Form as we require the original signed form.
By Post:
The signed Child Consent form and any printed referral form should be posted to the Area Office at the address below. You will also find the address on the form.

SHOULD YOU HAVE ANY DIFFICULTIES IN DOWNLOADING, OR COMPLETING THE FORMS PLEASE DO NOT HESITATE TO CALL OR LEAVE A MESSAGE ON THE DEDICATED LINE 

0844 561 7856