Address: 11/F, The Hong Kong Federation of Youth Groups Building, 21 Pak Fuk Road, North Point, Hong Kong
Tel: 2511 2235 Fax: 2507 2417
請轉介您身邊需協助的長者資料給我們。他們需要您的幫助!
Please refer the information of in-need-elders
to us. They need your help!
轉介個案表格
Case Referral Form (需協助長者Elder-in-need)
姓名
Name:
性別
Sex:
男Male
女Female
年齡
Age:
地址
Address:
聯絡方法
Contact Method:
需協助原因
Reasons for Assistance:
轉介者Referrer
姓名
Name:
聯絡電話
Contact Tel:
備註
Remarks:
本會將盡快與該名長者聯絡，並轉介至所屬地區之本會服務單位或其他有關機構跟進
We
will contact the elder-in-need as soon as possible,
and refer the case to our service units/other organizations
to follow up
以上個人資料只用作處理轉介用途
The
above personal information is for case referral
purpose only
