Access Statement

Professional Referral

This form is for professionals wishing to refer someone who could benefit from our support.

Before submitting the referral, please make sure you have the person’s consent to share their information with us. We keep all personal details safe, secure, and fully compliant with UK GDPR.

Thank you for helping us reach the people who can benefit from our support.

You can read more in our Privacy Notice.

Referrer Information

Please select the service you are referring this individual to:

First name

Last name

Email address

Phone Number

Message

I confirm that I have obtained the referred individual's explicit consent to share their details with disAbility Cornwall & IoS for the purpose of this referral. *

Is the referred individual aware of this referral?

Referred Person's Information

First name

Last name

Email address

Phone Number

Reason for referral

Would you like a copy of this email?

Yes