If you live in the Wakefield District and

• you have mobility problems because you are older or disabled
• or you find it difficult to look after yourself properly at home (such as getting out of bed, dressing or using the toilet)

then you may be eligible for care and support from Wakefield Family Services.

It is not possible to provide services to everyone. We aim to provide services to those people whose needs are critical or substantial.

To find out whether you are eligible or not, you will first need to make a referral.  To do this you can use this form.

About the Referral Form

• This form is for services for Adults (aged 18 plus) and Older People, but not for children.
• There are 5 pages to the form.
• This form asks basic questions about your health and abilities.
• The answers you provide will help us to assess how high or low your level of need is and whether you are eligible for services.

Completing the Referral Form

• Fields marked with a Red Asterisk * are Mandatory , so must be completed.
• If you wish to print the form, for your own records, click the "Printable Version" button on the form. You will need Adobe Reader to view and print the printable version of the form. This can be downloaded from the Related Links section.
• You can exit the on-line referral form at any stage by pressing the "Cancel" button. A formal application will only be made once you have completed the whole form and pressed the "Submit" button on the final page.

Other Contact Methods

This online form is just one way you can make a referral.  For more ways to contact Social Care Direct, see the Contact Details link in the Related Links section.