Make a professional mental health referral for a Care Act assessment

Make a professional mental health referral for a Care Act assessment

You can refer to Kingston Council’s adult social care service as a professional. This includes social workers, doctors, nurses, housing officers, police officers or other professionals who work with vulnerable adults.
Use this form for Section 117 aftercare referral and Care Act assessment requests where clients' needs are predominantly connected to their mental health.

If you want to make another professional referral, including for patients with dementia and no other mental health issue, use the general professional referral form.
Before you begin

This form has 6 pages and will take around 10 minutes to complete.
Do not use this form if it's an emergency. If you need to make a safeguarding referral, visit our website's safeguarding page to find the best way to contact us.

You can use this form to create a new referral if you are worried or concerned about an adult who needs support to:
- wash, dress or access and use the toilet
- stay safe around the home, including equipment and alarms
- access the community, leisure or work
- maintain relationships
Try to speak to the person to make sure they want help from us. We may not be able to help someone who does not want it.

Privacy notice

Read our adult social care privacy notice and data protection for information about how we process your data.
Check the box if you are happy to proceed.*

I have read and accept the privacy notice

Details of the person you're referring
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

Town or CityCounty

Postcode
Phone number*
Enter their phone number, for example 020 8547 5000
Email address
If you know their email address, you can add it here
Date of birth*

DayMonthYear
NHS number
This 10 digit number helps us process the referral.
Do they need an interpreter?*

YesNoI don't know
What language do they prefer to use? *
Tell us about anything they use to support their communication

Hearing aid or cochlear implantBritish sign language interpreterBrailleLarge print documentsOther

Before you begin