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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 Croydon, 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.

If you are a carer living in Lincolnshire:

If you are an adult carer aged 18+ living or caring for someone in Lincolnshire, please call the Lincolnshire County Council Carer Wellbeing Hub on 01522 782224 to register or click here to access the Support Request Form.

Complete form

Select your local service
Your details
Carer details
Carer's date of birth
Do they require an interpreter?
Please specify
Please specify
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Cared For Person Details
Please specify
Person cared for - medical conditions
Please specify
Referral Outcomes
Please specify
Please confirm
Please ensure the carer consents to the referral.
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