Young Adult Carers Referral

Young Adult Carer's Details
 
 
 
 
 
 
 
 
 
 
Risk Assessment

Does the carer present any risks to:

 
 
Reason for referral

Please include the reason for referral, including the impact and effect the caring role has on the young adult carer/you:

 
Name of Persons "Cared For"
 
 
 
 
Nature of Illness/Disability
 

If 'Substance Misuse' has been ticked, the young adult carer also has the option to engage with PKC Drug, Alcohol, Homeless & BBV Team for specialised support.

 
Other agencies involved with YAC and/or family:
 
 
 
GP practice to whom the young adult carer is registered.

Please note that if this section is completed yupr GP practice may be contacted toinform them of this referral. We would always encourage any young person to make their GP aware of their caring role.

 
 

If you are self-referring you do not need to fill in this section

Referral agents details

If you are self-referring you do not need to fill in this section:

 
 
 

Please request permission to make a referral on any young adult carer's behalf

 
 

Young Adult Carers Referral Form

Sarah Kidd at sarah.kidd@pkavs.org.uk
Tel: 01738 567076
Fax: 01738 440717

Definition of a Young Adult Carer:

Young Adult Carers are between the ages of 16 to 25 years and look after a friend or family member of any age due to disability, mental illness, chronic/terminal illness and/or problems relating to substance misuse.