Help To Claim – Agency Referral

Please use this form if you are a local agency or community organisation wishing to make a referral to us.

Referrer Details:

Client Details - Please enter the details of the person you are referring:

If we need to contact you, please select by which methods you are happy to be contacted.

Can we contact you for feedback?
We want to make sure our service meets your needs. To help us understand how we’re doing and to improve our service, we may want to contact you at a later date to ask for your feedback. Sometimes we need a trusted research organisation to help us do that.

We’ll decide who we contact for feedback based on the services you used and the advice area. We may also use your special category data so that we hear from different groups.

Please tick the box below if you agree to us getting in touch.