Request for Adult Social Care Support

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Online Professional Referral

This form should only be used to make a contact about a vulnerable adult where you believe that abuse has happened or is likely to happen.

Please use this form for less urgent concerns only. If you feel the person is in immediate danger, please dial 999 in an emergency.

This form will take 10-20 minutes to complete.

What will I need to complete this form?

You will be required to create an account, or log into an existing account, in order to complete and submit this form.

You will need to provide as many details as possible about the situation you feel we could support with. Please describe:

What help the person requires
What the person you are referring is finding difficult
What is currently working well
What outcomes the person you are referring is looking to achieve

Doing this enables us to prioritise correctly.

How long will it take?

This form will take 10-20 minutes to complete depending on the amount of information you need to provide.

Please be aware that for security reasons your session will timeout after 20 minutes of inactivity.

Saving a copy of the form

Please save your form regularly using the 'Save for Later' button at the bottom of the screen. This form will then be available for 31 days in your list of My Saved Forms.

Once you have submitted the form you will be able to see a copy in the ‘My Submitted Forms' section of the portal for 365 days; after this the form will no longer be visible.

To print the form use the 'Print' button at the bottom of the screen before submitting.

What other useful contact numbers are available to me?

You can also share a concern about an adult or to report alleged abuse directly to the First Response Team on 0800 137915

Do you need support with aspects of your daily living? you can contact the First Response Team on 01296 383204 or emailto:ascfirstresponse@buckinghamshire.gov.uk

What further information is available to me?

Buckinghamshire Safeguarding Adults Board (SAB) provides detailed guidance on safeguarding concerns for both public and professionals.
Getting care and support guide provides detailed guidance on the council offered services.

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