Adult social services referral form
Notes
This form is a 'Request for service' form otherwise known as a 'referral'. The form relates to Adult Social Services only.
Adult Services cover people over 18 years who have a disability or who have Mental Health or drug and/or alcohol problems and all older people (i.e. 60 years of age if you are female and 65 years if you are male).
Disclaimer: This authority is under a duty to protect the public funds it administers, and to this end may use the information you have provided on this form for the prevention and detection of fraud. It may also share this information with law enforcement agencies and other bodies responsible for auditing or administering public funds for these purposes. For further information, see "Privacy" below.