Please note, not all sections of this form need to be completed to make a referral but any additional information you provide at this stage will be helpful. Certain information must be provided in order for us to deal with your request (*denotes manadatory information).

If you are unable to do this, please call us on 01698 429090 or 01236 755550.

Please ensure that you have advised the carer that you will be sharing information with Lanarkshire Carers, and that they are aware that their outcomes may be fed back to Social Work by Lanarkshire Carers

Lanarkshire Carers will store and process the information provided on this referral form, or any subsequent information provided, in a secure and sensitive manner in line with relevant data protection laws.  This information may be used and shared anonymously with other partner organisations for reporting and monitoring purposes.  Lanarkshire Carers will not disclose any personal information provided with other organisations or individuals without explicit consent, unless a person’s safety and well-being is at risk.  

Further details on how Lanarkshire Carers uses personal information can be found on our website: www.lanarkshirecarers.org.uk/privacy 

A printed version of this policy can also be provided on request.

I (the carer) confirm that I have read and understand this declaration and give permission for my personal information/photograph to be stored.  If this referral is being made on behalf of a carer, I (the person making the referral) have explained to the carer how their personal information will be used and obtained their permission to share this information with Lanarkshire Carers.