Homesafe Plus

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This form is for use by health professionals only.

To complete this form you will need

  • your contact details
  • details of your question or enquiry

The Council take your privacy seriously.

We hold and process all personal information in line with data protection legislation.

You can find out how we manage and process your data in our privacy policy

I have read the privacy policy Required Required


Homesafe Plus tailors existing borough services to provide immediate support after discharge and, over the course of six weeks, will link patients to a variety of services available.

This form is to be used for referring to the following borough council services:

Community alarms and telecare (including emergency homesafe packs)

  • Meals at Home
  • Handyman/home improvement service including temporary key safes
  • Social prescribing
  • To inform us of a housing need

Please complete the referral in as much detail as possible. The form is designed to be as easy and quick as possible but provide us with enough information to understand the condition and needs of the patient as well as the services they require. It should take about five to 10 minutes to complete.

Once you have submitted the form, it will be sent to the relevant borough councils that require it to enable service delivery.

If you are having problems submitting your referral please email or call 01932425865 (9am to 5pm Monday to Friday), or 01932 425060 outside of these hours.