Elder Help Peel provides social prescribing programs (L2W) https://www.allianceon.org/Social-Prescribing to alleviate the effects of social isolation and loneliness among seniors age 55+ experiencing healthcare, medical conditions, mental health, and addictions within Peel Region. The information is collected to make the best possible volunteer match to an older adult match based on the needs of the senior referred to this program.

COVID-19 Vaccination: Please ensure that your client is aware that two primary vaccine doses plus copy of proof of vaccination required for our records for in-person social visits with a volunteer. If not vaccinated, telephone calls/wellness checks provided. ☐ C-19 Vaccination certificate uploaded with referral ☐ To be obtained by Elder Help Peel from the client.
Boundaries: Clinical work is not to be undertaken by volunteers. Additionally, volunteers do not move clients from one location to another and do not provide clients with clinical intervention, healthcare, personal care, or counselling.

Alternate Contact, Caregiver, Next of Kin (on behalf of client): Is aware, agreeable, and consents to this referral and sharing of personal health information with Elder Help Peel to assist with finding a screened volunteer match for in-person social visits/social telephone calls. Understands that their needs will be assessed, to determine the best possible match based on information gathered. • Yes If No, unable to proceed with this form. Please contact Michelle Di Natale directly at 905-457-6055 or via email at michelle@elderhelp.net for assistance.