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Referral form below (fields marked * are required):

In completing this form I consent to my data being used by Age UK Redbridge, Barking & Havering to contact me in the future and at no time will this information be shared with any third party without my consent.

Title *
Which borough do you live in?
Gender

Please note, unfortunately we are unable to provide the service if:

  • You are on steroid medication
  • You have haemophilia
  • You have diabetes
  • You take blood thinning medication such as warfarin

Please confirm you understand the eligibility requirements for this service?

Terms and Conditions *