This form should be completed by professionals to refer a family to our services. Please complete the form as fully as possible. If the referral is an urgent matter please phone the CARIS office on 020 8801 3004.

Referrer's Details

Client's Details




No recourse to public fundsBenefits receivedWorking

Reasons for Referral

Issue not coveredConflict of interestCase complexityNo capacity in agency

ChildrenDomestic violenceEducationEmploymentHousingImmigrationWelfare benefits

ClothesESOLFood parcelSafety equipmentSummer playschemeToy library

Data Protection

Referrals may only be made with the consent of the client. Information submitted on this form will be treated as confidential. For full details of how we process personal data, please read our website privacy policy and privacy notice for clients.

I have permission from the client to make this referral and to share with CARIS Haringey the information disclosed on this form and any additional information in relation to their case as appropriate.

I understand that a copy of this referral will be sent to me by email, and agree that CARIS Haringey may contact me and the client using the contact details provided.