A care professional discussing support needs with an older adult at a bright home table

For professionals

Refer someone for care

Use our secure referral form to tell us about the person who needs support. Our team will review the information and contact you to discuss the next steps.

Start a referral Contact our team

Secure referral

Professional referral form

Complete the sections below with the minimum information needed to open a referral. Fields marked required must be completed before submission.

Your details

Tell us who is making the referral and how we should reach you.

Full nameRequired

OrganisationRequired

Role / job titleOptional

Work emailRequired

PhoneOptional

Person requiring support

Please include only the information needed for us to understand the referral. We may contact you if further details are required.

Preferred name or initialsRequired

Prefer a preferred name or initials. Do not include date of birth, NHS number, diagnosis lists, medication detail, or other clinical records in this form.

Approximate age band

Support required

Share a clear, high-level summary of the support being requested.

Care needs summaryRequired

Detailed assessment, if needed, happens later with the referrals team through an appropriate channel.

Urgency

Funding context

Local authority areaOptional

Review and submit

Confirm the privacy acknowledgements, then send the referral securely.

Supporting documents

Document upload is not available on this form yet. If supporting papers are needed, the referrals team will request them securely after reviewing your submission.

I acknowledge the privacy notice and understand how Josben Care will use these details to handle this referral.I confirm I have appropriate authority or consent to make this professional referral on behalf of the person named above.

Looking for care for yourself or someone close to you?

Family and personal enquiries are welcome through our general contact form.

Make a general enquiry