Adult social care referral form

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Adult social care referral

Complete this form to make a referral to the City of York Council Adult Social Care Team.

You'll need to provide:

  • your contact details
  • details of the person who is the subject of the referral, if not yourself, including their;
    • date of birth
    • address
    • telephone and email
  • brief details of the situation which has led to the need for a referral

Please note: This form is not to be used for raising safeguarding concerns.

Report safeguarding concerns via the Safeguarding Adults Board website.

Please read the Adult Social Care Privacy Notice before starting your referral.

Have you read the Adult Social Care Privacy Notice? (required)