Relative / Carer Referral

Consent to share information (required)

Please tick to confirm that the above named person has given consent for their personal information to be shared with Care Network so that they can be provided with appropriate options to support their health, wellbeing and independence

The information you enter in to this form will be collected and stored by Care Network and used to contact you or the person referred, as indicated above, regarding this referral (required)

Please confirm that the person being referred understands this and has been directed to Care Network’s Privacy Notice which can be found at www.carenetwork.org.uk/privacy-notice

Please tick the box below if the person you have referred would like a paper copy of our Privacy Notice posted to them

Please post a paper copy of Care Networks Privacy Notice

A member of the Care Network team will make contact within the next 5 working days.

As detailed in the Privacy Notice, you can stop receiving information from us at any time. To do this, please write to us, ring one of our customer team on 01254 507255 or email us at [email protected]

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