Adult social care professional referral (not safeguarding related)

Use the following form to make an adult social care professional referral that is not related to safeguarding. If the referral is safeguarding related see abuse and safeguarding.

This form is for non-emergency referrals only. We aim to respond to concerns as quickly as is required, but please note this is not an emergency service.

You are asked to consider the immediate safety of the referred adult. If you believe this adult is in immediate harm or risk, please alert the appropriate emergency or other services to address this risk.

If you need support from Adult Social Care to manage an immediate risk, please call:

  • 023 8083 3003 during office hours (Monday to Thursday 8.30am to 5pm, Friday 8.30am to 4.30pm)
  • Out of Hours team on 0300 555 1373 outside of those times

Otherwise, please continue with this form:


Before you fill in this form

You won't be able to save this form to complete later, so please allow yourself at least five minutes to fill in the form.

  • If you are a care provider, please upload copies of care plans or logs from within the last two weeks
  • If you are a residential care provider and looking for an adult to move into nursing care, please provide copies of nursing assessments and a 72 hour behaviour chart
  • If you are from another local authority, please upload copies of any assessments of the adult made by the local authority and information about commissioned services for the adult
  • If you would rather upload a completed document about the adult, you can do so

Make an adult social care professional referral (not safeguarding related)