CONNECT referral form

This form is to request the CONNECT service only and should not be used to request social care assessments.

If you require a social care assessment from Carmarthenshire County Council, please visit the council website to access the form. You can only use this form for adults over 18 years of age. 

Filling in the correct form will help avoid delays in the referral process. 

Please use our general enquiries form if you have a general enquiry about our services. 

Do you still require our CONNECT lifeline service?

Thank you for visiting our website. If you need more information, please call 0300 333 2222 or email us at contactus@deltawellbeing.org.uk

Are you completing this form for yourself or on behalf of someone?
Are you a *
Has the person given consent to be referred? *