an older adult with a young carer laughing

Overview

Refer a carer to BCP Carer Support

Referrer Details

If you have any queries before completing this form, please contact the Carers Support Service on on 01202 128787. This form should not be completed by workers in Adult Social Care. Please note, this form should be used for carers supporting someone in Bournemouth, Christchurch or Poole only. If you wish make a referral for someone who cared for someone in Dorset, please contact Carer Support Dorset on 0800 368 8349 or visit their website www.carersupportdorset.co.uk

Name of Referrer (required)

Organisation (required)

Address (required)

Telephone Number (required)

Email (required)

Has the carer consented to this referral? (required)

Carer Details

Please provide details of the carer below

Name of Carer (required)

Address (required)

Phone (required)

Is it okay to leave a message if they do not answer? (required)

Carer preferred method of communication (required)

Who do they care for? (required)

Condition/diagnosis of the person they care for: e.g. dementia, mental health etc. (required)

Please tell us any other information that might help us better support the carer.

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