Our online referral form enables us to process referrals quickly whilst ensuring that we have a proportionate amount of information to do so. It is secure and we comply with with GDPR & NHS Information Governance accreditation. 

Most people using it report no problems however we have had a few reports saying that even though they have completed all mandatory fields (highlighted in red), they get an error message saying that they have not, as seen below.

If you receive this message, please ensure that you have completed the required fields which are highlighted in red on the form and summarised below:

Family Details - so that we can make contact & have an understanding of the situation Referrer's Details - so that we can contact you should we need further information
Carer's name Name
Carer's address Organisation
Carer's phone nos Job title
Date of referral Work email address
Cared-for person's address (just town is fine) Work phone no(s)
Relationship between care & cared-for ie spouse, mother etc Summary of situation including risk, priority etc
Summary of cared-for's disability Consent to make referral (yes/no & date)

If all the red sections are complete but you are still getting an error message, our developers have advised that this may be due to using an older browser or one that does not have Java Script enabled.

Following a successful referral you should see the message below and the referral form will turn blank ready for another referral.

It may be that your IT department can solve this issue for you however if this is not possible we do not want to cause any inconvenience or for carers to miss out on support. As such we can still receive referrals through other means:

We hope this information is of use however feel free to contact us if you have further queries.