Refer a caregiver to our services

If you are a health and social care professional working with an unpaid caregiver, you can register the caregiver to access our services. Please complete our external referral form below and we shall contact the caregiver as soon as we can.

External Referral Form – Caregivers Connected Gateshead

Referrer Details

Name(Required)

Carer Details

Name(Required)
Is their gender identify the same as their sex registered at birth?
Address(Required)
DD slash MM slash YYYY

Caregiver's Emergency Contact Details

Name of Emergency Contact

The person they care for

Name(Required)
Address(Required)
DD slash MM slash YYYY

Accessing Support

What services and support would the caregiver like to receive from us?

Caregiver Consent(Required)
DD slash MM slash YYYY

Cared For Consent(Required)
DD slash MM slash YYYY

Data Privacy Consent(Required)