Adult Social Care referral form
What is this form for?
This referral form is for members of the public who are finding it difficult to look after themselves or manage daily tasks.
What this form isn’t for?
- Urgent requests – please call 999 if you urgently need medical attention
- Professional referrals – please make a professional referral here
What does this form contain?
This form contains questions around your current situation and condition, as well as services and resources that you have used up to this point. As well as this, it asks about any future aspirations you have.
Before you complete this form it is important to make sure that you have explored the other options for support. Ensure you have:
- Spoken to friends and family to see what support they can offer
- Reviewed the directory of support services for activities and organisations which support your independence
- Looked for tools and equipment to support you from EquipMe
EquipMe
Make life easier in three simple steps with EquipMe, get impartial advice about tools and equipment to make daily living easier:
- Choose a topic
- Answer some questions
- Get advice
Before you fill in this form
This form will take 15-20 minutes to complete. Please allow enough time to complete this in one sitting as it cannot be saved to complete later.
This form is the fastest method in which to make a referral to the council for additional support.
