This form is for adult referrals. If you wish to refer a young carer (under 18) please complete our Young Carer form.
Please do not use this form to refer carers for a Carer's Wellbeing Grant. Carers referred to us will receive an informal review about their health and wellbeing with a Carers’ Resource member of staff. Some carers may then be eligible for a grant, but we cannot guarantee this.
By submitting this referral you agree that we may retain your details, as given on this form, on our secure database, in accordance with the Carers' Resource Privacy Policy.
You also agree on behalf of the person you are referring that we can store their details, as given on this form, on our secure database in accordance with the Carers' Resource Privacy Policy.
if you don’t know the full address of the carer, please tell us the city/town they are from. If you don’t know this, please write ‘not known’.
Please note: Please do not use this form to refer carers for a Carer's Wellbeing Grant.
