Make a referral

Please continue to refer.  Our service is operating normally via telephone and email.

Complete and submit an online referral form

Or type directly into this fillable PDF referral form

You may need to select an option to download the PDF in Acrobat, so if prompted or if on an Apple device, select the option to Create PDF.

Or you can also print and fill this form by hand: Word version of referral form

Carers in Southampton accepts referrals for carers of adults and children but can only provide carers assessments for carers of adults over 18 with additional support needs (disabled/ill/elderly) who live in the local area served by Southampton City Council.  If there are young carers in the household please also make your referral to the Young Carers service. Before you refer, please note that we do NOT provide respite, professional carers, home visits or provide crisis intervention.  If you are referring a carer to our service please click the link below, complete the form with the full consent of the carer, and return it to Carers in Southampton.