MEN’S REFERRAL FORM

Thank you for your referral we look forward to speaking to you soon. You will receive a confirmation email from The Cowshed to say that your referral is in progress. We may contact you if we require clarification or have items out of stock. Please note we only accept referrals via health professionals , charities, Churches , social services schools and other professional bodies. If you are struggling and are unable to access these services please contact us on our contact tab and we will do everything we can to help you.

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    YOUR INFORMATION

    THE CLIENT'S INFORMATION

    Is referral for Collection or Delivery (required)

    Shoes
    YesNo

    Shoe Type
    WorkbootsWalkingTrainersFormal

    Shoe Size

    Trousers
    YesNo

    Trouser Type

    Waist Size

    Jumpers/Tops
    YesNo

    Jumper/Top Size

    BEDDING

    Sheets

    Duvet Covers

    Pillows
    YesNo

    Duvet
    YesNo

    Curtains
    YesNo

    If an item is not listed please add them in "Other Items" section eg Scarves, Swimwear, Belts, Bags, Underwear, Towels)