Adult Services (North) Referral Form
Only complete the below referral form if you are a social worker or professional working in a PAC-UK subscribing local authority (see below list). Non-subscribing local authorities must contact the PAC-UK Advice Line (0113 230 2100) prior to completing this referral form. If you are making a One Adoption referral please click here to be redirected to the correct referral form.
Correct as at 16 May 2019.
Hammersmith & Fulham
Kensington & Chelsea
East Riding of Yorkshire
North East Lincolnshire
If you have any questions prior to completing the form, please contact PAC-UK's Advice Line on 0113 230 2100 or email firstname.lastname@example.org
Please include as much detail as possible on the referral form below. Fields highlighted with a red * symbol are mandatory and must be completed in order for you to submit the form.
At the bottom of the form there is a verification code you must enter before pressing submit (this is an anti-spam measure). The verification code can be any two digits of your choice, for example 12.
Once you have pressed submit, your form will automatically be sent to the PAC-UK Advice Line who will respond at the earliest possible opportunity. A notification message will appear on your screen confirming your referral has been received.
Note, failure to provide enough information could result in delays. Please read each question carefully to ensure all contact details provided are correct.