Dear Patient,

Good Neighbour Schemes can offer a range of services such as those indicated below that may be helpful to people living in the area. Please read the list and tick the boxes to show whether you might use these services and / or might be able to volunteer your time and help. You can tick boxes in both columns.

If you think you might be able to offer some time as a volunteer, the amount of time is entirely up to you – even a couple of hours a month helps! All volunteer expenses are reimbursed and all volunteers are fully insured and DBS checked for free (as appropriate).

Possible Services:

Q1. Occasional lifts to doctors, lunch clubs, shops, etc.?


Q2. Befriending – popping round for a chat over a cup of tea?


Q3. Form filling / letter writing / help with using a computer?


Q4. Collecting prescriptions, pensions, etc. / occasional help with shopping?


Q5. Small household repairs/practical tasks (such as changing a light bulb)?


Q6. Pet-care / dog-walking etc.?


Q7. Indoor plant watering / light gardening?


Q8. Being part of the phone rota, to answer callers and match them to a suitable volunteer?


Q9. Being part of the organising group – helping with publicity, fundraising, etc.?


Q10. Other – please specify?

Personal details (these details will only be shared with Practice staff and the Good Neighbour Schemes coordinators).



Telephone/ email:

Many thanks for your time in answering the questions in this survey.