Make a referral
Download a referral form
Below you will find our referral forms which you can use to make a referral. If you’d rather make a referral over the phone, please call us on 0330 440 9000 during office hours.
If you’re making a referral for yourself or someone you know:
Please use a standard form
If the referral is for someone else, you will need to get their consent, or tell us why this isn’t possible (for example, they do not have the mental capacity to do so).
If you’re making a referral for Independent Health Complaints Advocacy, you must also complete a consent form. Consent forms must have a written signature, please print the consent form, sign and scan/take a photo or post to the address at the bottom of the page.
If you are a professional and would like to make a referral for someone you’re working with:
Please use a professional form
You will need the consent of the person you are referring, or tell us why this isn’t possible (for example, they do not have the mental capacity to do so).
Once you’ve filled out the form:
Email it to
Post it to the address at the bottom of this page.