Professional referral form:

Young person details
Details of the young person who performs caring role.
Name of young person *
Name of young person
Address of young person
Address of young person
Date of birth *
Date of birth
Parent/Carer details
Details of the Parent/Carer/Guardian
Parents name *
Parents name
Parents address
Parents address
Details of the caring role
Name of person 'cared for'
Name of person 'cared for'
Please include contact details. If known, please include any services/professionals supporting the cared for person as well as the carer - this will help us to develop a holistic picture and ensure our work is joined up with other services.
Has a North Tyneside Council Young Carers Needs Assessment been completed for this Young Carer?
Does the young person have a social worker?
Please give name.
Please give name.
Referrers details
Name of referrer *
Name of referrer
Is it safe to visit the family home/visit alone? *
Socially/ emotionally/educationally or physically?
Please refer to our website for details of the services we provide.
Are the parents/ carers aware of this referral?