Easy
Steps to Request Bereavement Support / Make a Referral

Cruse Bereavement Care has trained volunteers throughout the counties of North Wales and we match clients as closely as we can to the locality and their individual needs. To help us do this efficiently and as quickly as possible, please download and complete the appropriate form or forms below.

WHICH FORMS SHOULD I 
DOWNLOAD?

Self Referral
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

Download this form to submit parental/guardian consent for a child/young person under 18.  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 the 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