Make a Referral

Reason

  • Carer
  • Cared for
  • Reason
  • Consent
  • Send

Adult Carer

Name

First line of address

Second line of address

Town

County

Postcode

Email

Telephone

Secondary telephone

Date of birth (dd/mm/yy)

Gender

Relationship to cared for person

Ethnicity

Your GP Practice

Health of carer

Has a formal Carers Assessment been carried out by local authority?

Other information (additional caring/childcare responsibilities, current circumstances)

Where did you hear about Carers Lewisham?

Cared for

Cared for name

Cared for address (if different from carer)

Date of Birth

Gender

Ethnicity

GP

Disability/Health problem

Has a Care Needs Assessment been carried out by the local authority?

How does the disability/illness affect them?

Reason

Reason for referal

Carer Consent

I agree that Carers Lewisham’s staff and volunteers can process my personal details to enable appropriate support to be identified for me and the person I care for.

I give my permission for my personal details to be shared with other partners involved in the delivery of the service in accordance with the new General Data Protection Regulation (GDPR)

I understand I can withdraw my consent at any time by contacting info@carerslewisham.org.uk or 020 8699 8686

I confirm that I am happy to be contacted by

Cared for person’s consent

I agree that Carers Lewisham’s staff and volunteers can process my personal details to enable appropriate support to be identified for me and my carer.

I give my permission for my personal details to be shared with other partners involved in the delivery of the service in accordance with the new General Data Protection Regulation (GDPR)

I understand I can withdraw my consent at any time by contacting info@carerslewisham.org.uk or 020 8699 8686

Consent on behalf of the cared for person

TO THE CARER: Please fill out the below section only if the Cared for Person is: Under 18 and you are the parent, guardian or tutor; lacking in mental capacity and you have legal rights to sign on their behalf

I agree that Carers Lewisham’s staff and volunteers can process the cared for person’s personal details to enable appropriate support to be identified for them and myself.

I give my permission for the cared for person’s personal details to be shared with other partners involved in the delivery of the service in accordance with the new General Data Protection Regulation (GDPR)

I understand I can withdraw the cared for person’s consent at any time by contacting info@carerslewisham.org.uk or 020 8699 8686

GPDR

We will never share your personal data with any outside agency or company without your permission unless required to do so by law. You are entitled to view your record at any time by giving us 48 hours notice in writing.

Refer a Young Carers (8-18 years old) 

If you would like to refer to Carers Lewisham a child or young person for young carers support or to find out what other services are available within the borough please complete the form below:

The Children and Families Act 2014 and Care Act 2014 gives young Carers rights to be assessed by local authorities in order to address their need for support as well as to safeguard against inappropriate care.

If you are worried about a child or are concerned about an on going issue involving a child please contact the Multi-Agency Safeguarding Hub (MASH) directly on 020 8314 6660 (out of hours call 020 8314 6000) or email them on mashagency@lewisham.gov.uk.

For urgent child protection referrals, contact the MASH on 020 8314 9181. If you think a child or young person may be in immediate danger, call 999 or contact your local police on 101.

Young Carers Referral Form

Adult Carers Referral Form

Carers Lewisham
Waldram Place
Forest Hill
London
SE23 2LB

Opening Times:
Monday to Friday 9am-5pm

Carers Lewisham is a Carers Trust Network Partner and is accredited by Advice Quality Standard Mark.

We are funded by London Borough of Lewisham, NHS Lewisham (CCG), Children in Need, Donations and Legacies.

Registered Charity No: 1073592
Company Registered in England No: 3681548

All content copyright Carers Lewisham 2018