105 Chauncy St. Boston, MA 02111 friend@fw4elders.org 6174821510

Make a referral

Do you know an elder who would like to have a friendly visitor, or some short-term assistance? Service providers, family members, and neighbors are all welcome to refer someone for our programs.  You can also refer yourself!

Our eligibility requirements: 

We serve seniors who:

  • Are over 60 years of age
  • Live in Boston or Brookline
  • Are free from moderate to severe cognitive impairment and drug or alcohol addictions
  • Are over 55 years of age with a visual or hearing impairment

If you would like to make a referral to our program, please call us at 617-482-1510 or fill out the form below. One of our volunteer coordinators will be in touch with you within the next few business days.

Click here for more details about the various programs we offer.

Your name:*
Your e-mail:
Your phone number:
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What is your relationship with the elder you are referring?*
Are you a healthcare professional referring a client? *
If you answered yes to the above, what is the name of the organization you work for?
If you answered yes to the above, what is your title?
What is the zip code of the elder's residence? *
What program are you interested in for your elder? *
Description of request:*
Type the characters you see here: