Refer to our services

HOW WE CAN HELP

Refer Someone Else to Our Services

If you know a friend, family member, or client who could benefit from VASL’s services, please use this secure form to pass on their details. Our project team will be in touch within 5 working days to discuss how we can help.

Looking for support for yourself? If you want to register for our services yourself, please go to our Request Support for Yourself page.

Eligibility & Catchment Checklist

Please check our area guidelines below before submitting your referral to ensure the person you are supporting is within our catchment areas:

Service area

Available Services

Across Leicestershire

Harborough District

Eastern Side of Harborough District (Up to A5199)

Detailed Eligibility Breakdown

Someone relies on you for their care.
You are over 18 years old and care for someone who is also over 18.
The person you care for lives in Leicestershire. (Note: If they live in Leicester City, please contact Age UK).

You do not have access to your own transport and have difficulty using (or no access to) public transport.
You live on the east side of the A5199 within the Harborough District.
Your destinations are within Leicestershire, Northamptonshire, or Nottingham.
You are able to get in and out of a standard car independently.

You are aged 60 or over and live alone.
You live within the Harborough District.
You do not have a diagnosis of dementia or serious mental health issues.

You are aged 18 or over and live within the Harborough District.
You are experiencing mild-to-moderate mental wellbeing challenges and have a desire to make a positive change.

If you would prefer to have a casual chat with our staff before filling out the form, you can warmly contact us at 01858 456 042 or email wellbeing@vasl.org.uk.

Referral Form

Please complete the details below, and our project team will be in touch to discuss the service in more detail.

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Your Details (Referrer)

Your Full Name*

(referrer)

First Last

Your Phone Number*

Your Email Address*

What is your relationship to the person needing support?

Please provide more details:

Do they consent to you making this referral?

Yes

Person Requesting Service (Client)

Full Name of the person needing support

First Last

Their Phone Number

(if different to yours)

Their Email Address

(if different to yours)

Home Address

Please provide the address where the support or service is required

Street Address Address Line 2 City County / State / Region ZIP / Postal Code

How Can We Help?

Which of our services are you interested in?*

(Select all that apply)

Support for Carers - Leicestershire

Car Scheme - Eastern side of Harborough

Community Champions (Befriending) - Harborough

Digital Support - Harborough

Community Wellbeing Harborough - Harborough

Please give a brief overview of how we can help

Contact Preferences

Who should our team contact to follow up?*

Thank you for taking the time to fill in these details. As soon as you click submit, our team will get to work. Someone will be in touch with you or the person you are referring within 5 working days.

If you would like to download a form to fill in, please click here.

If you would like to download any of our project leaflets, please see our Leaflets page.