Homeshield referral form

Fill in a Homeshield referral form online if you are a visiting professional or volunteer in the Homeshield partnership.

Homeshield is a scheme to promote and support the health, wellbeing and safety of potentially vulnerable people within their homes.

If you are a visiting professional or volunteer and encounter a vulnerable person who requires help or support in their home you should complete a Homeshield referral form.

The quickest and easiest way to do this is by completing and submitting our online form.

Make a referral

To refer someone to the Homeshield Partnership you will need to provide the following information:

  • Your details (name, job title, organisation, telephone number)
  • Information about the person being referred, including:
    • Name
    • Date of birth
    • Address
    • Telephone number
    • Gender
    • Ethnicity
    • If they are a homeowner or tenant (if they are a tenant, landlord details will be required)
    • If they, or someone in their family has been in the Armed Forces
    • What kind of help they need
    • If they have any disabilities or impairments
    • National Insurance number
    • If they have had or would like an entitlement check
    • If they receive and benefits, including Pension Credit, Attendance Allowance or Disability Allowance
    • Details about how they feel in their home and whether they can get around the home easily


Once you have submitted your referral we will review it and take necessary action.

If we feel that we need to contact you, we will use the contact details you have provided.

Reporting online helps us to save money which can be spent on services elsewhere.

However there are other ways to contact us to report a problem or find out more information: