Request Involvement from Adult Social Care

Professionals can use this form to make a request for support from health and adult services, including requests for:

• care act assessments
• occupational therapy assessments
• living well support
• equipment and adaptations

You'll need to provide:

• confirmation whether the subject of the referral has provided consent
• details of the person you are referring, including;
  • age, gender and ethnic group
  • contact details and address
  • details of any communication needs
  • NHS and GP details
• details of any third party contact, if we cannot contact the person being referred directly
• details of the property where the person being referred resides
• brief details of the situation which has led to the need for a referral
• your details and details of your organisation

If you are not requesting involvement in a professional capacity, you can see information on requesting involvement as a resident on our website:

• Get adult social care

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.