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Concern for Someone's Wellbeing

How to Navigate

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use the Click on the numbered sections on the left hand side of the window or use the and options to move through the pages. DON'T use the Browser 'Back' button as you might lose information. image. and Click on the numbered sections on the left hand side of the window or use the and options to move through the pages. DON'T use the Browser 'Back' button as you might lose information. image. options to move through the pages.


DON'T use the Browser 'Back' button as you might lose information.
When submitted, the data collected on this form will be treated confidentially and only used by Leicestershire County Council for the purpose of providing information, advice and support to meet needs, and to safeguard vulnerable adults. To be able to do this, information may be shared with relevant agencies.

The information provided on this form will only be shared as allowed by current Data Protection Law.

The Form

Questions You DON'T need to answer every question, you need only complete what is relevant. image. Questions

You DON'T need to answer every question, you need only complete what is relevant.
Select the option(s) that best describe the situation. image. Select the option(s) that best describe the situation.
This symbol This symbol indicates that the question is mandatory and must be answered in order to continue. image. indicates that the question is mandatory and must be answered in order to continue.
A small blue question mark A small blue question mark after a question shows where there is further information. If you hover your mouse pointer over the question mark you will see the help text. image. after a question shows where there is further information. If you hover your mouse pointer over the question mark you will see the help text.
When entering a date, please use the calendar rather than typing the date into the box.
Please note, you will be logged out after 15 minutes of inactivity - please make sure you save your form if you are called away from your computer.

Options

Save the Form

Use the Save the Form Use the option to Save the form to return to at any time in the next 30 days. image. option to Save the form to return to at any time in the next 30 days.

Print the Form

Use the Print the Form Use the option to Print a copy of the form if required. Once you have submitted a form you will no longer be able to see it, so it is a good idea to print off your form before submitting it. image. option to Print a copy of the form if required. Once you have submitted a form you will no longer be able to see it, so it is a good idea to print off your form before submitting it.
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