Professional Referral

For further information about Adult Social Care and community services in Cheshire West and Chester, visit the Live Well Cheshire West website.

Please note that this form should be used to submit referrals for adults (over 18) only If you wish to report a concern about a child, please use the following form: Report a concern about a child. Further information on reporting a concern about a child is available on the Cheshire West and Chester Council website: Information on reporting a concern about a child.

Once submitted, this form will go to the Cheshire West and Chester Community Access Team. You will receive a confirmation email message once the form is submitted and follow up calls if required. The team aim to respond within 3 working days. Please complete this form to the best of your ability and with as much information as possible.

If the person is at risk of falls and this is new for them or occurrences have increased, please contact the persons GP or their Care Community Team.

You will be able to upload supporting documents to this referral, which may reduce the need to duplicate the information provided throughout the form. Please make reference to attached documentation in your answers, where relevant.

Please be aware that if you do not provide enough information this referral may need to be returned to you for further details.