Social work services referral form - page 1 of 1

This form is for non-urgent requests and for South Lanarkshire residents only.

If your request is urgent and during office hours (Our office hours are: Monday to Thursday 08.45 hours - 16.45 hours and Friday 08.45 hours - 16.15 hours), please contact your local social work office.

If your request is urgent and outwith office hours or on a public holiday, please contact our emergency out of hours service on: 0800 811 505.

Please note: the asterisk* indicates required information

Request details

*Are you requesting a service for yourself?

*Please give details of the support needed and why this is required (maximum 800 characters).

Details of referral

*Title	Other
*Forename	*Surname
Date of birth (dd/mm/yyyy)	If date of birth is not known, please select an age group
*What is the preferred method of contact with this person	*Is the person aware of the referral?
If you have answered no to the previous question we will contact you for further information.
*Address	*Town/City
*Postcode	*Area
Phone	Fax
Email
*Gender	*Ethnicity
*Are there communication difficulties?
If there are communication difficulties what are these? i.e. will require a signer due to hearing difficulties
*Will an interpreter be required?	*Are there disability issues?
*Have you contacted Social Work Resources before?

About you

Details only required if different from above.

Title	Other
Forename	Surname
What is your relationship to the person this request relates to?	How would you like us to contact you?
Phone	Fax
Email

South Lanarkshire Council complies with the Data Protection Act.

Social work services referral form - page 1 of 1

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