Refer Someone to LGTBQ+ Support Services

Your name * Name of your organisation * Your contact number * Your email * What is the name of the person being referred? * Contact number of the person being referred * In case we are unable to contact the person being referred by telephone, does the person referred give consent to being contacted via email? * If yes, what is their email address? What kind of support are they looking for? * Other - please specify: What is their postcode? *

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

What is their date of birth? * How do they describe their sexual orientation? * Other - please specify : How do they describe their gender? * Other - please specify: Is this the same as the sex they were assigned at birth? Are they able to communicate easily in English? * If not, what language do you speak? Do they have a disability? * If yes, what disability or disabilities do they have?

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.) ? * If yes please specify: Do they have any mobility issues? * Are there any adjustments that they need us to make for them? Do they have a carer (someone who helps care for them)? * 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