General Advocacy Form

referrer - a

Who are you requesting support for? *

Myself
My Client
A friend / family member

What area does the person requiring support live in? This helps us to assess if our services cover that area *

Other
South Devon
West Devon
South Hams
Teignbridge
Torbay
Tavistock

Unfortunately the services your requesting aren't provided by Vocal Advocacy in your area.

There will be another advocacy organisation that does.

To find out where you can get support, search online for ‘advocacy + your city or county’ or ask your local authority.

If you are a professional trying to make an out of area referral, please download a referral form here and email it to vocaladvocacy@btconnect.com or call 01803 868300.

Are you looking for: *

Statutory Advocacy Services (Care Act)
General Advocacy Services
Advocacy for Parents in the Child Protection Process

Section One

Tell us about the person requiring advocacy support

Name *

First

Last

Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date of Birth *

Has the person given consent for the request to be made? *

If unable to consent is the request made following best interest decision making *

Does the person have a learning disability? *

Does the person experience difficulty in communicating? *

Does the person experience mental ill health? *

Is the person vulnerable? *

Do they pose a risk to others? *

Is a lone working risk assessment in place? *

Please describe the reason for your advocacy request. *

Diversity monitoring

These questions help us monitor diversity and inclusion. It is completely optional and does not affect any decisions.

What is your gender?

Female
Male
Non-binary
Other
Dont now / prefer not to say

What is your ethnic group?

Don't know / Prefer not to say
Asian Bangaladeshi
Asian British
Asian Indian
Asian Other
Asian Pakistani
Black African
Black British
Black Caribbean
Black Other
Chinese British
Mixed Other
Mixed White & Asian
Mixed White & Black
White British
White Irish
White Other
Other

What is your religion?

No religion
Don't know / Prefer not to say
Christian
Buddhist
Hindu
Jewish
Muslim
Sikh
Other

Section 2 - About the referrer

Referrer contact information

Name *

First

Last

Phone

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Relationship to the individual *

Other professionals involved (please provide contact details)

Privacy

The Information you provide will only be used in connection with the provision of advocacy and not for any other purpose. For more information on how we use your data, see our privacy policy.

I agree to be contacted about my advocacy referral *

Captcha *

What is 7+4?

General Advocacy Support

Section One

Diversity monitoring

Section 2 - About the referrer

Referrer contact information

Privacy

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