Self Enquiry Form

Read our Easy-to-Read guide to the NAS service here to find out more about this service.

Your Details

Name

Age

Gender

Address

County

Telephone

E-mail

We need your information to know if we are the right service for you.
Please answer the following questions.

WHAT WOULD YOU LIKE THE ADVOCATE TO SUPPORT YOU WITH ?

HAS ANYONE ELSE SUPPORTED YOU WITH THIS ?
(this might be family member / friend / social worker / GP or anyone else)

IF YOU WOULD LIKE TO TELL US SOMETHING ABOUT YOUR DISABILITY, PLEASE DO SO BELOW;

PLEASE USE THE SPACE BELOW TO ADD ANYTHING ELSE YOU FEEL IS OF IMPORTANCE
(i.e. are there specific days of the week or times of the day when it is easier to contact you to arrange a first meeting or any important dates coming up)

We will keep your information confidential. There are some occasions when an advocate will have to give your personal information without your agreement. This will be if:
you are in danger,
you are a danger to someone else
a court order asks for your information
a child is in danger of abuse

I confirm that I have read and understood the NAS data protection notice

I confirm that I accept the terms as stated.