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.

Barking & Dagenham
Barnet
Brent
Camden
Croydon
Ealing
Enfield
Essex
Hackney
Hammersmith & Fulham
Haringey
Harrow
Havering
Hillingdon
Hounslow
Islington
Kensington & Chelsea
Lambeth
Lewisham
Medway
Newham
Redbridge
Suffolk
Tower Hamlets
Waltham Forest
Westminster
West Sussex
Barnsley
Bradford
Calderdale
Doncaster
East Riding of Yorkshire
Gateshead
Hull
Kirklees
Knowsley
Leeds
Lincolnshire
Liverpool
Newcastle
North East Lincolnshire
North Lincolnshire
North Tyneside
North Yorkshire
Northumberland
Rotherham
Sefton
Sheffield
South Tyneside
Wakefield
Wirral
York


If you have any questions prior to completing the form, please contact PAC-UK's Advice Line on 0113 230 2100 or email referrals@pac-uk.org

If you have any questions prior to completing the form, please contact PAC-UK's Advice Line on 0113 230 2100 or email referrals@pac-uk.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.

All information processed in relation to your enquiry and/or booking adheres to PAC-UK's Privacy Policy.

Note, failure to provide enough information could result in delays. Please read each question carefully to ensure all contact details provided are correct.

Referring Local Authority /Agency

 

Referring Social Worker /Professional

  • Address of Local Authority /Agency

 

Details of person being referred

  • Address

  • Disability

 

Name/s of other household members

 

Details of child/ren

 

Adoption details of person receiving service (if applicable)

 

Reasons for referral

 

Document upload

 

Verification (for anti-spam)