Adult Care referral form for professionals

What this form is for 

This form is only for professionals. If you’re not a professional and would like to make a referral, use the Adult Care referral form for the public.

You should fill in this form if you:

• think that the person you want to refer has care and support needs and would like to discuss these needs with somebody
• want to follow up a referral that already has been made
• want to add information to a referral already made

What this form is not for

This form is not for:

• emergency situations: call 999 if you, or an adult you're referring, needs urgent medical attention
• equipment and adaptations requests: if you want to refer yourself or another adult to occupational therapy, fill in an occupational therapy referral
• reporting safeguarding concerns such as abuse and neglect: you'll need to complete a safeguarding form

For advice and support for carers visit the Carers Support Centre.

How long the form will take to complete

The form should take around 15 to 20 minutes to complete.

Make sure you have enough time to complete the form in one go, as the form cannot be saved and returned to later.

You must complete the form as fully as you can. A lack of information is likely to cause a delay and may leave a person unsafe.