Refer a carer


Please complete this form if you wish to refer an adult carer that you know in a professional capacity.

If you are a professional referring a carer, please ensure that you have sourced permission from the person you are referring. If you have not sourced prior permission, please do not complete this form. Please note: we cannot process the referral if the carer in question has not given permission for Wigan and Leigh Carers to contact them. If you have any questions, or would to prefer to refer via the telephone, please contact us on 01942 705959.

All fields must be completed or the referral will not be accepted.

By submitting this professional referral, I confirm that the carer has given me consent to refer them to Wigan and Leigh Carers Centre and they are aware that I am making this referral. The carer has agreed for the personal data contained in this referral to be shared with you.

Adult Carer information

Name(required)
DD slash MM slash YYYY

Information about the cared for

Referrer details

Referrer name(required)
Agreement

Once a referral is submitted, a member from our Carer Triage Team will contact them to discuss their caring role. Depending on the circumstances, we can provide information, support and personal plans to help that person move forward.