Grant Scheme Eligibility - Carers aged over 55 Mental Health Referral Form to be completed by a Professional wishing to refer an Adult Carer "*" indicates required fields Barnet Carers Referral Process All referrals are sent to our Carers Services Team. We aim to follow-up the referral within 3 working days. Once we have contacted the carer, someone from our Adult Carers Team will email you with a progress update. At busy times, these planned times may be extended. Importance in acquiring Carer's Consent It is important to receive the consent of the named carer. We require the confirmation that the consent of the carer has been given as part of this referral in order to proceed in making contact on completed submission.Has the person you are referring given consent for this referral?* Please tick this box to indicate that consent has been givenPlease complete the questions below Name of Professional* First Last Please state the name of your organisation*Are you wanting to refer a carer under the age of 18?* Yes No Referral to Barnet Young Carers Should you be wishing to refer a young carer, our referral form for the young carers service can be accessed by clicking Barnet Young Carers Professional Referral.Job Title of Professional*Contact No. of Professional*Email of Professional* How did you hear about us?*-Please select from options-WebsiteColleagueProfessional ForumLeafletOtherIf Other, please state*Name of Carer* First Last Please give the person's full birth nameGender of Carer*-Please select from options-MaleFemaleTransgenderNon-binaryPrefer not to sayCarer's Date of Birth* DD slash MM slash YYYY Carer's Preferred Contact No:*Carer's Email Does the carer require an interpreter?* Yes No What is the carer's preferred language?*Please enter the postcode below and click on the Lookup Postcode button Carer's AddressCityPostcodePlease select services that the carer would be interested in accessing via Barnet Carers (select as many that apply)* Carers Needs Assessment and Support Plan General information and advice Form-checking (for benefits forms) Training Carers Trust Grant Emergency Card Scheme Counselling Health and Wellbeing Services (i.e. exercise classes, peer-support groups, social events) Barnet Leisure Pass This field is hidden when viewing the formMain Area of Need [Age UK]-Please select from options-DementiaFrailtyLong-term conditionThis field is hidden when viewing the formMain Area of Need [Barnet Mencap]-Please select from options-First ChoiceSecond ChoiceThird ChoiceThis field is hidden when viewing the formMain Area of Need [Inclusion Barnet]-Please select from options-First ChoiceSecond ChoiceThird ChoiceThis field is hidden when viewing the formMain Area of Need [Mind]-Please select from options-First ChoiceSecond ChoiceThird ChoiceThis field is hidden when viewing the formOther Area of Support-Please select from options-First ChoiceSecond ChoiceThird ChoiceIs the carer affected by any medical or health condition?* Yes No Not aware of If Yes, what condition is the carer affected by?*-Please select from options-Autistic Spectrum Disorder (ASD)Learning DisabilityCancerDementiaMental Health IssuePhysical DisabilityDrug/Alcohol DependencyFrail Through AgingOtherPlease give additional details on diagnosisWhat is the relationship between the carer and the person being cared for?*-Please select from options-BrotherDaughterFatherFriendGrandchildGrandparentHusbandMotherNeighbourParentPartnerSisterSonStep ChildStep ParentWifeOther relativeIf Other, please state*How long have you or your organisation been supporting the carer?*-Please select from options-Less than 6 months7-18 monthsOver 18 monthsPlease give details of the support provided that may help us gain a better understanding of the carer's situation*Is there a person(s) under the age of 18 involved in caring for the named Person(s) Being Cared For? Yes No Are there any young carers involved? If you wish to refer a young carer, please follow this linkName of Person Being Cared For* First Last Person Being Cared For's Date of Birth* DD slash MM slash YYYY Please enter the postcode below and click on the Lookup Postcode button Person Being Cared For's Address*City (Person Being Cared For's)*Postcode (Person Being Cared For's)*Barnet Carers Partners Forum The forum has been created with the collective aim being to better support the carers across Barnet. By inviting organisations who may be in regular contact with carers and bring their individual area of expertise to share their views on a regular basis, it is our aim that carers can access specific support between organisations. If you are interested in representing your organisation, please indicate below. I would like to be contacted regarding the Barnet Carers Partners Forum* Yes No Receiving Feedback Regarding Your Referral We do not generally provide feedback on referrals due to pressure on our resources. However, if there is a particular reason for you needing a response, please give us details and we will do our best to accommodate your needs. . Would you like us to provide a response for this referral?* Yes No Please provide the reason for your need for a response to this referral*Professionals Supporting Carers - Mailing List To join our mailing list for professionals, please click on this link, Mailing List for Professionals Supporting Carers . Next Steps On submission of your referral, you will be emailed a PDF copy for your records. A member of the Adult Carers Team will be in touch with the carer to complete our registration form and carers assessment. We will make 3 attempts to contact the carer to complete these forms. In the event we are unable to get in touch with the carer, we may seek your assistance in making the carer aware of our communication attempts. Referrers can re-refer after closure. While we endeavour to respond to your referral as soon as possible, depending on our available staff resources, it may be up to 10 working days before we contact the carer you have referred. Δ
