If you want to make a referral to our Care Act Advocacy service, please fill in the form below. To make a referral:

  • You must be a social worker working with someone currently undergoing a Care Act assessment
  • A person must be going through one of the following processes to be eligible for Care Act Advocacy:
    • Assessment of Need
    • Care and Support Planning (preparation)
    • Care Review (review of Care and Support Plan)
    • Carers Assessment
    • Safeguarding (enquiries and reviews)
    • Child’s Needs Assessment (sometimes know as a transition assessment)

    Part 1: Care Act Advocacy Referral

    1. Is the person going through a social care process? Please select main process below. A person must be going through one of these processes to be eligible for Care Act Advocacy (see Section 7.19 of the Care and Support Statutory Suidance)

    YesNoDon't Know

    YesNoDon't Know

    YesNoNot yetPerson lacks understanding or awareness

    Part 2: Referral Information

    2. Relevant Person's Details (person requiring advocacy)


    3. Reason for advocacy referral? (Please include a summary of the advocacy issue/decision being made, upcoming meeting dates, deadlines, priority areas etc.)

    4. Referrer details

    5. Friends and/or family (Is there an appropriate person to support the person’s involvement?)


    6. Other relevant information about the person requiring advocacy

    YesNoDon't KnowPrefer not to say

    Acquired brain injuryAutistic Spectrum ConditionBlind/partially sightedCarerCognitive impairmentDeafDementiaLearning disabilityLong-term health conditionMental health needsOlder person (frailty)Physical condition/illness

    Word Referral Form

    If you are having issues with our online referral form, we have a version of it in Microsoft Word. To make a referral this way, please download the document by clicking on the button below, complete it and email it to [email protected]. Please also get in touch if you have any questions about the referral form.