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Professional's adult carer referral form

If you're a professional supporting a carer living or caring for someone in Essex, Southend-on-Sea, Medway, Lincolnshire and the London Boroughs of Hackney, Haringey, Merton or Waltham Forest you can refer them to us for specialist, localised support. Once a referral is submitted, a Carer Support Adviser will make contact within 5 days to discuss their caring role and the challenges they're facing.

Depending on their circumstances, we can provide information, support and personal support plans to help carers achieve a better balance in their lives, supporting carers to thrive and live their life to the fullest.

Complete form

Select your local service
Your details
Carer details
Do they require an interpreter?
Mother, son, friend...
What reason(s) are you referring the carer for?
Are there any known safeguarding issues or risks which Carers First should be aware of?
If the carer is aged 18 to 25 (Young Adult) are they in education and/or working?
Please confirm
Please ensure the carer consents to the referral.