Covid-19 Community Assistance Hub referral

Your details

Use this form to make a referral to a Community Assistance Hub for yourself or on behalf of someone else.

You can find out more information about what the Community Assistance Hubs do on our website.

Please answer the questions in this form in as much detail as possible so we can assist you the best we can.

The information you enter into this form will be shared with other partners which can provide support, such as Social Work, NHS and Voluntary Partners. To find out how we will use your data you can view our Privacy Notice.  

Our mailboxes are not monitored 24 hours per day, if you need assistance with a critical COVID related matter please call Customer Advice and Support on 0300 100 1800 rather than completing this form. You may be directed to an alternative ‘out of hours’ emergency contact number when our call centre is closed, you will be advised of this if necessary.

This form will time out after 20 minutes inactivity.

Address Required
Who is this referral for? Required
Help: Please enter DD/MM/YYYY.

Contact details

Is any communication support required? Required
Help: This could be in the form of a translation service (if English is not the first language) or British Sign Language support.