Self Referral for Adult Social Care

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What is a self referral?

You can complete the self referral form if you think you might need support, information or an assessment from the Council.

A self referral is a simple form where you can tell us a little about yourself and what you might need support with.

On receipt of the referral we will contact you to have a conversation with you about things you might be able to do to help yourself or to arrange an assessment. For information about assessments please click the link. /health-and-social-care/assessing-your-needs.aspx


How can I complete a self referral?

You can complete a self referral online by completing the self referral form.

You can also phone the Council on 0300 456 0111 to have a conversation about your care and support needs.


Can I complete a self referral for someone else?

You can send a referral on behalf of someone else but you will need to ensure that you have obtained their consent before sending this. If the person has not agreed Wiltshire Council will not be able to progress the referral.

You will need to provide an email address for both yourself and the person being referred. This cannot be the same email address. An account will be created in your name.

On submission of the form an email will be sent to the person being referred saying a referral has been received on their behalf. They will be invited to activate their account. Once this is done they will be able to see the referral you have sent on their behalf.

If required the person being referred can request that someone else is given access to their account to see information / manage their account. Wiltshire Council would confirm this request with the person being referred prior to access being given.

Data Privacy and Protection

Completing this form confirms you agree to the Adult Social Care Information Notice and the Adult Social Care Privacy Notice


Helpful hints

It would be helpful if you could answer all the questions and provide as much information as possible. This will help us to understand your situation and what support, advice and information you might need.