Completing a Home Shield referral form

The Home Shield referral form is quick and easy to use, and helps you to assess what the customer needs.

When filling it in:

  • Always complete the top part of the form with details of the person being referred
  • Always complete the bottom of the form with the referrers details
  • Get confirmation of consent from the person being referred at the bottom of the form

The main part of the form is divided into four sections, depending on the needs of the person being referred.  You only need to complete the parts of the form which indicate what the person needs help with.

You should always leave a copy of the Home Shield public information leaflet with the person you are referring.

If you have any questions or queries, email us at

Was this webpage helpful?