One Adoption Referral Form

Only complete the below referral form if you are a social worker or professional working in One Adoption North & Humber, One Adoption West Yorkshire or One Adoption South Yorkshire.

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

PAC-UK is the lead provider in a service (funded by One Adoption) working with 15 Local Authorities to provide support to anyone in the region affected by adoption.

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.

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 Statement.

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
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Details of person being referred
This should also include anyone listed in \'other household members\' and \'details of children\' sections of this form.
Name/s of other household members
Details of child/ren
Please add any other relevant supporting information here, including any additional children.
Adoption details of person receiving service (if applicable)
Reasons for referral
Please advise us of any safeguarding or contact issues. It is important that this information is provided from the outset to enable planning of our services.
Please list any other information or issues we should be aware of at this stage here. If you would like to send supporting documents with this referral please email these directly to as soon as you have submitted this referral form.