Form – Young carer Make a referral

Important - please read carefully

This form is for use by professionals who wish to refer a Young Carer to Carers Link for support.

Please do not use this form to refer anyone over the age of 18. Instead, please use the separate professionals referral form for adult carers.

1. Your details (referrer)

2. Young Carer's details

Young Carer's address (including postcode)
Please describe these if yes

3. About the caring situation

4. What kind of help does the young carer give to the person they care for?

Help with medication
Help with personal care
Help with domestic jobs
Providing emotional support
Helping with communcation
Helping with appointments
Looking after siblings

5. How does the young carers caring effect

Health
Emotional wellbeing
Balance between life & caring
Education
Other
(please provide details if yes)

6. Safety

7. What kind of support does the young carer require?

Time out from caring
Opportunities to meet other young carers
School work/ homework
Someone to talk to
Whole family support
Planning for the future

8. How is the young carer coping in their caring role at the moment?

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