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Health professionals adult contact referral form

Completing a health professionals adult contact referral form.

To make a health professionals adult contact referral, please complete a health professionals adult contact referral form.

To determine an individual's social care needs we require a minimum of data. This information will enable us to process your request more efficiently and provide a better outcome for your client.

Client consent is essential to further this referral. GPs and other health professionals are requested to consider continuing health care needs prior to completing a referral.


Complete referral form


Once you have completed and submitted the online form you will be advised to save or print the completed form for your own records.

All the information in the form is confidential. Use of this form acknowledges that this is a routine referral, for which the response time will be anything up to 72 hours.

If you have any follow-up information or issues regarding the content of a referral please contact the adult care office you submitted the form to on their GCSX email account to ensure information remains secure.