Make a referral to the multi-agency adults at risk panel
You must be a professional to use this form and need to make a referral to the multi-agency adults at risk panel.
Safeguarding referrals and members of the public
This is not a safeguarding referral form.
If you're a member of the public or need to make a safeguarding referral visit our report suspected abuse or neglect of an adult web page.
Before you start
- the name, address and date of birth of the adult at risk
- to know how the adult at risk describes their gender
- to know if the adult at risk is aware a referral is being made
- the adult at risks Liquid Logic or NHS number, if known
- the details of any other people who may be involved, if known
- the reason for making the referral
- the actions that have already been taken
- your name, the agency and team you work for, your job role
- the details of any other professionals who may be involved, if known. This should include name, job role, agency and email address
Your session will automatically end if you do not use the form for 20 minutes. If this happens, you'll need to start your referral again.Start now
How we use your data
We primarily use your data for processing your referral. This may then be shared with other government departments in accordance with our organisational privacy notice. We never sell your data to third parties or use it to market to you without your consent.