Referral Form for Carer Assessment

This form is for professionals to refer an individual for a carers assessment. This also gives access to the Universal Carers Service, which meets many carers’ needs. Before you complete this form please be aware: 1) We operate waiting lists so please read our guidance on referral for assessment 2) You must have the carer’s consent to pass their information onto us 3) You will need to complete all the compulsory questions marked (required) We’ll process and record the personal data on this form in accordance with our privacy notice. If you need any help completing this form please contact [email protected] or call 0114 278 8942.

SECTION 1: These questions are about the carer you are referring to us and their caring role
SECTION 2: These questions are about the person being cared-for.

Please do not ring us until after you have sent in the referral form as we cannot have a Triage conversation with you until we have received all the essential information?

SECTION 3: These questions are about you as the referring professional.