Request support with care online

Live article 35883 LETSTALKFORM

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
1. Are you completing this form for yourself?*
  
  Yes
  
  No, someone else
2. Your relationship
  1. Are you caring for this person?
    
    Yes
    
    No
  2. What is your relationship to the person you are referring?
  3. Does this person give consent for you to refer them?
    
    Yes
    
    No
Your details
2. Your name
  1. Title*
  2. Title*
  3. First name*
  4. Last (family) name*
3. Phone number*
4. Date of birth*
5. What is your NHS number?*
6. Current living arrangements*
Your address
4. Postcode*
6. Select your address*
7. Address
  
  You have selected:
  
  Address
About your needs
1. What would you like to talk to us about?*
Getting in touch
1. 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
1. Your name
  1. Title
  2. Title
  3. First name
  4. Last (family) name
2. Phone number
Your address
3. Postcode
5. Select your address
6. Address
  
  You have selected:
  
  Address
Data protection
1. 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.
  
  Adults and Integrated Care Privacy Notice

Session timeout

Request support with care online

How we can help

Emergencies

0191 424 6000

0191 456 2093

Address

Address

Address

Address

Confidentiality

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