Only fill in this form if you need help as a consequence of the current situation (Corona virus). If you need urgent medical help, phone your GP.

You can’t get out of the house and need help with shopping? You are lonely and would welcome a chat with someone? You need help at home? Fill in the form and we will look for someone to help you. Then all you need do is contact that volunteer and make the necessary arrangements. Be sure to follow the general guidelines.

  • 1Gegevens
  • 2Overzicht
  • 3Bevestiging

Personal information

Details of the person requiring help

Please provide as much information as possible about the person who needs help. If you don’t have the contact details of that person, if necessary the volunteer will contact you to make arrangements.  

At what address is help required?

Address

What sort of help?