Core details
- Client name, preferred contact method and consent to be contacted.
- Primary location where support is requested.
- Referral source and best contact for follow-up questions.
- Funding pathway, plan dates or payer context where applicable.
- Preferred start timing and any known scheduling constraints.
Support needs
Briefly describe the practical support being requested. This may include daily living support, community access, personal care, high-intensity support, nursing-related needs where appropriate, or help coordinating a broader support plan.
Safety and service-fit context
Include known risks, manual handling considerations, behaviour support context, equipment needs, access issues, allergies, communication needs and any relevant escalation instructions. Detailed clinical records should be shared through appropriate referral channels, not public contact forms.
What happens next
CCG reviews the referral against service area, workforce capacity, funding, consent, clinical scope and urgency. If more information is needed, the team will contact the referrer or nominated contact before confirming next steps.