Health & Social Care enquiry form

Use this form to ask Community, Health and Social Care for advice and to find out if we can help, if appropriate someone will contact you to make an appointment with a social worker.

If there is an emergency or your enquiry is urgent, please DO NOT use this form. During office hours contact a social work team or telephone 0161-794 8888 at other times.

If you think that someone is in immediate danger, then please phone the emergency services on 999.

About your enquiry

I am enquiring about: myself someone else

who is a:
child (under 18 years old)
older person (65+ years old)
other adult

If you are enquiring about someone else, do they know you are making this enquiry?
yes
no

Information or advice

I want information or advice about
(Hold down Control key to select more than one item)

Other advice

If your enquiry isn't listed above, or you want to give us more details, please use the space below.

Details of the person you are enquiring about

If you are enquiring about someone else, please give us as many of their details as you can.

Title (Mr, Mrs, Ms, Dr, etc)

First Name

Last Name

Date of birth

House number and street name

Area

Town

Postcode

Telephone number
(Please include area code)

Email Address

Your details

Please give as much information as you can. You must give us at least one method of contacting you.

Title (Mr, Mrs, Ms, Dr, etc)

First Name

Last Name

House number and street name

Area

Town

Postcode

Your country (if not United Kingdom)

Telephone number
(Please include area code)

Email Address

Contacting you

How would you prefer us to contact you?

phone email fax letter

What is the best time to contact you? (UK time)

morning (8:30am - 12:30pm) afternoon (12.30pm - 4:30pm)

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Salford City Council, Salford Civic Centre, Chorley Road, Swinton, Salford M27 5AW

0161-794 4711

Improving people's lives IN Salford