How to refer yourself
- Have a learning disability
- Are 18 or over
- Live in the South Birmingham AreaClick here to view areas
- Are happy to share your personal details with us
- If you can't fill out this form by yourself, ask someone to help or call us on 0121 4750777 and leave a message.
We use the same form for everyone. This means it asks for the referrer's details first, even if you are doing it for yourself.
We are sorry if this means you have to put your details in twice.
We will look at your form as soon as we can and decide who is the best person to help you.
Before you fill out our referral form please read our CASBA Client Privacy Notice which informs you how we keep your information and describes circumstances as to how we may share them, as permitted under the new Data Protection Laws introduced in May 2018.