Refer Yourself to HIV Support Services | MESMAC

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Refer Yourself to HIV Support Services

Refer yourself to MESMAC's HIV support services using our online form. Tell us about you and our team will be in touch.

Use this form to refer yourself 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.

Are you living with HIV? 

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

How do you describe your gender?  
Is this the gender you were assigned at birth?
Do you 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 you have any mental health or neurodivergent conditions (anxiety, dyslexia, autism etc.)  
What is your living circumstance?
How will you get to our office?  
Are you able to communicate easily in English?  
Do you have mobility issues? 
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

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Read our privacy statement