Find Support

We are here for you. Taking the first step is simple.

We want to make accessing support, education, and community as easy and stress-free as possible. There are no long waiting lists, and you do not need a referral from a doctor to get involved.

Choose the path that works best for you below.

Enter your first name.
This field is required.
Enter your surname.
This field is required.
Enter your telephone number.
This field is required.
If known, please enter your NHS number.
This field is required.
Enter your address line 1.
This field is required.
Enter your city.
This field is required.
Enter your county.
This field is required.
Enter your postcode.
This field is required.
Enter your borough (optional).
This field is required.
Reason for Referral
Select the reason for referral.
This field is required.
Please provide any more information that is relevant.
Tick the box to agree to sharing information as described above.
This field is required.
GP Practice*
Select your GP practice from the list.
This field is required.
Enter the full name of the referrer here.
This field is required.
Provide contact details for the referrer including phone number and email.
This field is required.
Referrer Job Role*
Select the job role of the referrer.
This field is required.
Enter the name of the organisation the referrer represents.
This field is required.
Patient Title
Select the title of the patient.
Enter the patient's first name.
This field is required.
Enter the patient's surname.
This field is required.
Enter the NHS number of the patient, if available.
This field is required.
Enter the patient's telephone number.
This field is required.
Enter the patient's mobile number, if available.
This field is required.
Enter the first line of the patient's address.
This field is required.
Enter the city of the patient's address.
This field is required.
Enter the county of the patient's address.
This field is required.
Enter the postcode of the patient's address.
This field is required.
Check this box if the patient has no fixed address.
Client Contact Preferences
Select preferred contact methods for the client.
Enter the first name of the carer, if applicable.
This field is required.
Enter the surname of the carer, if applicable.
This field is required.
Enter the telephone number of the carer, if applicable.
This field is required.
Enter the carer's mobile number, if applicable.
This field is required.
Enter the name of someone who can be contacted regarding this patient.
This field is required.
Provide phone number or email for the trusted contact.
Reason for Referral *
Select the reason for the referral.
This field is required.

Need Help Filling Out the Form?

If you prefer to speak to someone directly, our team is happy to help you get registered over the phone or answer any questions you might have.

  • Call or Text us: [Insert Phone Number]
  • Email us: support@togetherforallcic.org
  • Opening Hours: Monday to Friday, 9:00 AM – 5:00 PM
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