Refer Someone to HIV Support Services | MESMAC

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Refer Someone to HIV Support Services

Refer someone else to MESMAC's HIV support services using our online form. Provide their details and our team will be in touch.

Use this form to refer someone to Bradford Yorkshire MESMAC HIV support services. We aim to contact you within 24 hours after receiving your referral. Please note that we don’t usually work weekends.

In case we are unable to contact the person being referred by telephone, does the person referred give consent to being contacted via email? 
Is the person referred living with HIV? 

Please be aware that we only cover Bradford Metropolitan District postcode areas.

How do they describe their gender?  
Is this the gender they were assigned at birth? 
Do they have a disability?  

We will contact you for more information and if we need to make any adjustments

Please be aware that we only cover Bradford Metropolitan District postcode areas.

Do they have any mental health or neurodivergent conditions (anxiety, dyslexia, autism etc.)  
What is their living circumstance?
How will they get to our office?  
Are they able to communicate easily in English?  
I have read and understood the Yorkshire MESMAC privacy statement and agree to the use of my data in line with this policy  

Find link to privacy policy at the bottom of the page

Thank you for taking the time to fill this out, our service is confidential and all the information given here will be destroyed after we have made you a confidential service user number. 

Yorkshire MESMAC privacy statement

Click 'find out more' to read

Read our privacy statement