Make a Referral

How to Access Our Services

We know that arranging care, whether for yourself, a loved one, or someone you support professionally – can feel like a big step.

You might be feeling overwhelmed with information, unsure where to start, or simply need someone to listen and guide you through the process. That’s exactly what we’re here for.

If you’d like to access one of our services, the first step is easy: just get in touch. You can fill in the referral form below, and one of our amazing team will contact you to talk things through.

We’ll take the time to understand your situation, answer any questions you have, and explain what support might look like for you.

We accept referrals from:

Individuals and families
Healthcare professionals
Social workers and Local Authorities
Hospital discharge teams
Charities and community organisations

You don’t need to have everything figured out before you speak to us – we can help assess needs, explore funding options, and guide you through the next steps.

If you’d prefer, you can also reach us directly:

📧 Email: info@aqthomecare.co.uk

📞 Call: 020 8531 5239

Whether your referral is for complex care, supported living, or help at home, we’ll respond promptly, treat your enquiry with sensitivity, and work with you to put the right support in place as quickly as possible.

Referral Form

Personal Details of Individual

Individual Name

Date of Birth

Address

Gender

Pronouns

Primary Diagnosis

Ethnicity

Religion

Hours of support required

Personal Details of the Person Making the Referral

Your Name

Relationship to Individual

Telephone Number

Contact Details of Social Worker/Care Manager (where known)

Local Authority

Name and Job Title

Department or Team

Telephone Number

Mobile Number

Service Requirement Information

Service Type

Area

Specific Service or location

Funding Information

How is the service for the Individual funded? If you are unsure, then contact us we can explain all available options

Overview of the Individual Requiring Care and/or Support

Please give a brief overview of their needs including; diagnosis, accommodation needs if appropriate, where they need support specifically. Also, a little bit about their likes and dislikes.

Select the type

Medical Conditions

Please provide information about any medical conditions that will need to be taken into consideration when delivering care and/or support

Are there behaviours or difficulties of concern?

There behaviours or difficulties

Other (please detail)

Areas of Care and/or Support
Please tick the relevant column to give us an idea of the levels of support needed

Housing Support