South Gloucestershire Village Agents

A new project supported by South Gloucestershire Council providing five rural Village Agents .

The Village Agents provide a free confidential service of one to one support, signposting to information, support and professional services by promoting health and wellbeing to help maintain independence.

To make an enquiry please contact your Village Agent direct if known (see below), or email Project Manager Tina Huckle-Mills tina@wern.org.uk Alternatively, you can phone 07502 641 805

To make an online referral, please complete and submit the form here

**Team work makes the dream work! - Team meeting in Aust - June 2024**

Over the last ten years South Gloucestershire has seen a rise of over 20% in people aged 65 and over, not least in the more rural areas. Many villages will now benefit from WERN’s Village Agent service, through a two year pilot funded by South Gloucestershire Council’s ‘Age Well’ programme, enabling people to stay healthy and independent for longer. The areas covered include Marshfield and environs, Cotswold Edge, Severn Vale, and Pilning & Severn Beach. Each is covered by a local Village Agent, working in the community. Village Agents help people connect with the services they need, particularly for those who are potentially vulnerable or isolated.

**Aimee Cherry Williams**

**Area:**
Marshfield, Doynton, Dyrham, Cold Ashton, Tormarton, Pucklechurch & Wick
**Telephone**
**07555 460 655**

Make an online referral here

Online Referrals

Please complete for self referrals and professional referrals

1) Is this a Self referral or for someone else? (if Self go to Question 4 onwards)

2) Your name

2.5) Your contact details

3) What is your relationship to the person you would like us to help?

4) Name of the person who you would like us to help?

5) Contact details of the person you would like us to help

6) Please indicate if you or the person asking for help prefers to be visited away from the home address

7) Date of Birth

8) What is the preferred means of communication?

Phone call? A letter or email? Interpreter? Please give more details here.

9) Next of kin, family member or trusted friend who helps with communications or is required to be in attendance

10) Primary reason for this referral

Please do not include medical history on this form but you can indicate if the issue relates to a medical condition. We will call you for more details if needed.

11) Please indicate if other organisations or professionals are currently involved. Is their support directly related to the reason for your referral?

The following questions relate to the person who is asking for our help. As we make home visits we need to understand more about the property we are visiting.

12) Does the person asking for a visit need time to get to the door or have a key safe or entry system?

Do not provide codes or secure information on this form.

13) Is there a dog at this property?

Please advise us if we need to take precautions or remind the person to place the pet in another room.

14) Is there parking at the address or any issues we should be aware of relating to safe parking?

15) Is there any reason why our staff should not visit this person alone?

Call the Village Agent for your area as we may reject this referral request.

Please add any further information here

South Gloucestershire Village Agents

A new project supported by South Gloucestershire Council providing five rural Village Agents .

Aimee Cherry Williams

Paul Jones

Alistair Vickery

Elizabeth Woodland

June Tov

Online Referrals