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    Report a safeguarding concern or alleged abuse to adult social services

    You have told us that you wish to report an incident of alleged abuse or a safeguarding concern about an adult.

    Please complete the following questions, giving as much detail as possible.

    Your submission will be looked at by a social care professional, who will inform you of the outcome.

    All fields marked with an asterisk * are mandatory.

    Details of the adult at risk

    Do you know their name? *
    Do you know their name?
    Are they known by any other names?
    Are they known by any other names?
    Do you know their date of birth? *
    Do you know their date of birth?
    Date of birth *
    Date of birth
    Gender *
    Gender
     
    Address

    Additional information

    Are there any communication issues? *
    Are there any communication issues?
     
    Has the adult at risk agreed to further enquiries? *
    Has the adult at risk agreed to further enquiries?
    Is the adult at risk deemed to have capacity? *
    Is the adult at risk deemed to have capacity?
     
    Please select all categories that apply to the adult at risk *
    Please select all categories that apply to the adult at risk
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    © Northamptonshire County Council  

    All personal data we collect from you complies with the data protection principles. Read more.