Request support with care online How we can help Complete the form below and one of our trained Adult Social Care Advisers from the Let's Talk team will be in touch with you soon. They will listen to what really matters to you and assist you to connect with support to enable you to get on with your life independently. To read about what support is available, see support and care. Emergencies If it's an emergency, please phone us immediately on: 0191 424 6000 Mon to Thurs 8.30am to 5pm, Fri 8.30am to 4.30pm. 0191 456 2093 Evenings, weekends and bank holidays. Referrer details Are you completing this form for yourself? * Yes No, someone else Your relationship Are you caring for this person? Yes No What is your relationship to the person you are referring? Please select My husband My wife My partner My mother My father My brother My sister Other relative My friend My neighbour My customer My patient (Doctor) My patient (Occ. Therapist) Do they know they are being referred? Yes No Your details Title * Mr Mrs Miss Ms Dr Cllr Name First name* Last (family) name* Phone number* Age range * Please select 18-25 26-33 34-45 46-55 56-65 66-75 76-85 86-95 95-100 100+ Current living arrangements * Please select With partner With husband or wife With mother or father With sibling Other Your address Postcode* Address * About your needs What would you like to talk to us about?* Getting in touch When would be the best time(s) for an Adult Social Care Adviser to call you? * Monday (morning) Monday (afternoon) Tuesday (morning) Tuesday (afternoon) Wednesday (morning) Wednesday (afternoon) Thursday (morning) Thursday (afternoon) Friday (morning) Friday (afternoon) Your details Title Please select Mr Mrs Miss Ms Dr Cllr Name First name Last (family) name Phone number Your address Postcode Address Data protection Confidentiality The information you provide will be held securely and confidentially by South Tyneside Council. To enable us to support you we may need to discuss your circumstances with other professionals. You would be asked before this happens. We are happy to discuss any worries you may have. See the Adults and Integrated Care Privacy Notice How would you rate the information on this page? Good Average Poor
