0300 111 9000

Mon, Wed & Fri 9am-5pm,
Tues & Thurs 8am-8pm

0300 111 9000

Mon, Wed & Fri 9am-5pm, Tues & Thurs 8am-8pm

Refer a Carer

All questions marked with an asterisk-*- are required

    Carers Details:

    18-2526- 6465-8485+

    MaleFemaleNon Binary

    Any other ethnic groupAny other mixed backgroundAsian/ Asian British- BangladeshiAsian/ Asian British- PakistaniAsian/ Asian British-IndianBlack - other backgroundBlack/ Black British- AfricanBlack/ Black British- CaribbeanChineseGypsy or Irish TravellerMixed- White & AsianMixed- White and Black CaribbeanWhite and AsianNot obtained/ refusedOther- White backgroundWhite BritishWhite Eastern European

    Information from Gloucestershire Carers Hub on your privacy

    We collect and use your personal information to provide carer support services effectively and to meet our statutory duties under the Care Act 2014 and other relevant legislation. We will collect only the personal information we need to perform our duties. We will collect your name and contact details as well as information relevant to your support needs. The Gloucestershire County Council and PeoplePlus Privacy Notice outlines the types of information we are required to capture, the reasons for this, and our commitments to privacy regarding all information that we hold.

    As a referrer you should provide a copy of our Privacy Notice, either electronically or in hard copy, to the carer. Our Privacy Notice can be found here.

    Please tick to confirm that you have provided the carer with details of our Privacy Notice.

    Carers Caring Details:

    Prevent carer breakdownSocial activities / Time for selfManaging physical / mental healthManaging financesSkills and understanding of caring roleSupport to remain in employmentEmotional supportContingency planning

    Referrer Details

    Professional referral/Current intervention:

    YesNO

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