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Agency Referral Form

Please use this form if you are from another agency and are referring a vulnerable adult or someone who is at increased risk of fire and require Fire Service advice or Safe and Well Visit for the person.

You can find contact details for us here if you need to contact us in another way or about another matter.

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You should get a on screen message saying your information has been sent if there has been a successful submission.

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How we use your information: North Yorkshire Fire and Rescue Service (the Authority) as the data controller will process your information in line with relevant data protection laws. To find out more about how we will use the information you provide on this form and for the visit please view our  Privacy Notice here: http://www.northyorksfire.gov.uk/privacy

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Details of person you are referring

Risk/Vulnerability factors relating to the person you are referring

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