Self Referral

If you are an adult carer aged 18 or above and would like to refer yourself for our services you can complete our self referral form below.  We are here to help you.

If you have an unpaid caring role for someone over the age of 18 who has a long-term illness or disability, please complete the form below.

Your contact details

About the person you are looking after

Their details

How can we help you?

Data Protection

To continue with your referral we will need to add to our secure database. We will only use your and their personal information to provide you with information and signpost you to other services that relate to your caring role. You and the person you care for can request removal from our database by contacting