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Carer Emergency Contact Card Referral Form

As a partner of Carers Support West Sussex and West Sussex County Council, we need an agreement with you for direct professional referrals on behalf of carers seeking a Carer Emergency Contact Card (CECC).

For more details to share with carers, visit our dedicated CECC page.

Important Information

Current Agreement

If you're unsure about the current agreement, please contact us at 0300 028 8888 or email to speak with our CECC team.

Referring a Carer

When referring a Carer for a CECC using the online form, please remember:

1. Obtain the carer's consent for Carers Support West Sussex to store their information.

2. Complete all mandatory fields on the form before submission.

Doctor with clipboard and speech bubble over head beside patient details

Professional’s Referral Form

Use the form below to refer a Carer for the Carers emergency contact card

    Your Details

    Carer Details

    Details of people who have agreed to offer to help in an emergency

    First Contact

    Second Contact