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

The form will ask you information about:

• The person you are concerned about
• Your details
• Details of alleged abused/suspect your concerns
• What additional support may be helpful?
• What are the sources of your noticed concern(s)?

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.

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

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

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

To print the referral after submitting, you can access it via 'My Submitted Forms'

• You can also share a concern about an adult or to report alleged abuse directly to the Early Resolution and Safeguarding Team on 0800 137915

• Do you need support with aspects of your daily living? you can contact the Early Resolution and Safeguarding Team on 01296 383204 or email ascfirstresponse@buckinghamshire.gov.uk

• 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.