Refer Yourself to LGBTQ+ Support Services

Name * Mobile number * Email * What kind of support are you looking for? * Other - please specify: What is your postcode? *

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

What is your date of birth? * How would you describe your sexual orientation? * Other - please specify : How do you describe your gender? * Other - please specify: Is this the same as the sex you were assigned at birth? Are you able to communicate easily in English? * If not, what language do you speak? Do you have a disability? * If yes, what disability or disabilities do you 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 you have any mental health or neurodivergent conditions (anxiety, dyslexia, autism etc.) ? * If yes please specify: Do you have any mobility issues? * Are there any adjustments that you need us to make for you? Do you have a carer (someone who helps care for you)? * 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