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Adult referral form

The online self referral form is for adults over 18 years of age only. If you wish to contact us about someone who is under 18 years of age, please phone 01267 234567 or email: direct@carmarthenshire.gov.uk.

NB: If you are contacting us on behalf of someone else you will need their consent except if the person is at risk of being abused by others or if they are not capable of providing consent.

Apply online

If you cannot complete the online form please call Careline+ on 0300 333 2222

Your information

The information you share with us in this form will help us understand what support you or the person your are contacting us about may need. This means that we may need to share information with other Health and Social Care Professionals; so that we can work together to help provide support that best suits the needs of the individual. This may include sharing information with other organisations such as Hywel Dda Health Board and GP Practices.

The information will be handled in accordance with the Data Protection Act 1998 and kept secure at all times. For more information about the use of the information provided in this form, please visit our Data Protection pages.

Page updated on: 17/08/2017

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