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If you’re caring for someone who cannot manage without your help and support due to an illness, disability, mental health problem or addiction—and you’re not employed to do this—you are a carer. Newcastle Carers is here to listen and support carers of all ages. Fill in this quick and simple form to help an adult carer get the support they need.
What to expect from completing this secure form: Any information shared with Newcastle Carers via this form will be stored securely , please see https://www.newcastlecarers.org.uk/privacy-policy/ for more details. If you would like any further information, please call 0191 275 5060 and speak to one of our friendly team.
Once this form has been submitted a member of the team will contact the person with caring responsibilities within two working days to talk about their situation and how we can help.
Tell us about you:
Are you a carer (self-referring) or a professional referring on behalf of a carer?
Does the person who is cared-for live in Newcastle?
(please note, Newcastle Carers supports carers looking after someone who lives in Newcastle. If the cared-for person lives in another local authority area please contact us on 01912755060 to discuss available support)*
Carer Details
First name(s)*
Surname *
Date of Birth*
Gender*
Carers' own illnesses or disabilities?
Carers' ethnicity
Carers' sexual orientation?
Is an interpreter required for the carer?
Carers' Preferred Language
Carers' Address*
Address line 2
Address line 3
City
Carers' Postcode:*
Carers' preferred contact telephone number:*
Landline telephone number (if carer has one):
Email Address:
Has this carer given consent to this referral being made?*
Details of the person being cared for:
First name of the person being cared for:
Surname of the person being cared for:
What is their date of birth?
What is their main disability?*
Additional Information:
Are there any risks that you want our staff to know about?
Do you care for more than one person ?
Where did you hear about Newcastle carers?
Referrers' contact details:
Referrers name*
Organisation you work for:*
Organsiation address:*
Postcode*
Mobile Telephone No:*
Email Address:*
Newcastle City Council has developed the Adult Carers and Safeguarding Risk Assessment Tool to help front-line workers from ALL services identify carers:
Please read the Guidance Notes for the Adult Carers and Safeguarding Risk Assessment Tool.
If the person you want to refer to us has any known risks, please complete an Assessment Tool, and along with their Referral Form, send it to referrals@newcastlecarers.org.uk.