Duty to refer form

Which local authority does the service user want to be referred to?*

Eastbourne Borough Council
Lewes District Council

I confirm that I have discussed the referral with the service user and they have consented to the referral and to having their contact information shared*

Other public authority

Name of person making the referral*

Referrer's job title*

Referrer's email address*

Referrer's telephone number*

Referrer's work address*

Name and contact details of any other person who can give further information on the person being referred (e.g. support provider)

Session timeout

Choose or change your council

This website uses cookies

Duty to refer form