Making a referral

If you are a health professional, please read the information below about how to make a carer referral to Carers Hub.

Adult Carers Referrals

If you know of an adult carer aged 18 or over, first let the carer know you are making a referral and then complete as much information on the referral form below as possible. We will contact the carer to outline the support we can offer.

PLEASE NOTE : Because of the demand for our services it may take a number of days for us to get back to you and the carer

Referrer Details

Your name (required)

Your job title (required)

Your email (required)

Your contact details (required)

Reason for referral (required)

Carer Details

Carer's name (required)

Carer's date of birth (required)

MaleFemaleOther

Carer's address including postcode (required)

Carer's email

Carer's landline number

Carer's mobile number

OK to leave a message
YesNo

Sensory or communication needs e.g. interpreting?

Other members of the carer’s household
(please list names, ages and relationship to carer)

Has the carer consented to you sharing their information with us and agreed that we can contact them?
YesNo

About the cared-for person

Cared for person's name (required)

Cared for person's date of birth (required)

Cared for person's gender
MaleFemale

Cared for person's address (if different from carer’s)

Relationship to carer (eg parent/partner/friend)

What is the cared-for person’s health condition and how does it affect them?

Cared for person's GP surgery

Are there any services or agencies involved?
(e.g. a care agency/Crossroads respite service)

How can we help?

Type of support

Are you aware of any issues related to safeguarding, impacting on the carer or cared-for person? If yes, please give details

Are you aware of any risks to workers/volunteers making home visits?
If yes, please give details

Any other information