This form is for self referrals where you wish to tell us that you are at risk of or are being abused or neglected. We will ask you about your care and support needs and how they affect your ability to protect yourself. For professionals, providers and agencies, please make a
Safeguarding Professional Referral.
How long will it take to complete the referral?
- This referral may take around 10-15 minutes to complete, depending on the amount of information you provide.
- When you create an account, you will be able to save your form regularly using the 'Save for Later' button at the bottom of the screen. The form will then be available for 60 days in your list of My Saved Forms.
- Please be aware that, for security reasons, your session will timeout after 30 minutes of inactivity unless you click Retain Session. You will receive a warning message two minutes before.