Submit a Referral

This page is for anyone who would like to refer someone to Ellia’s home help services within Gloucestershire.

We accept referrals from a wide range of people: GPs, social prescribers, support workers, family members and others involved in someone’s wellbeing. All we ask is that the person being referred has given their consent.

Once submitted, we’ll be in touch within 24 hours to begin the next step.

Your Name

The name of the person submitting the referral

First Name

Last Name

Your Email Address

Your Phone Number

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Client's Name

The name of the individual you are referring

First Name

Last Name

Client's Email Address (if applicable)

Client's Phone Number

Required

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Comments

Optional