Self Referral

Please use this form to let us know if you or someone you care for would like to join any of our services. We may well need further information to you, in which case we will contact you, but this form will help us to understand whether you are eligible to receive our service and if so, which ones you may benefit from and enjoy. If you're not sure if you are eligible, please just fill in the form and we will be able to check for you. If you are completing the form on behalf of someone else, please make sure they consent to the referral.