Referrals

Advocacy is a free and confidential service.

Advocacy referrals can be made to Speak Out for someone who:

has a learning disability
is 17+ years old
lives in Brighton or Hove
We aim to respond to all referrals within two working days.

How to make an issue advocacy referral:

Download and SAVE a referral form before filling it in:

Advocacy Referral Form

Self Referral Form

Once you've filled it out, you can email the form back to:

[email protected]

Or post it to our offices at:

Speak Out, Brighthelm Centre, North Road, Brighton, BN1 1YD

How to make a care act referral:

Care Act referrals are accepted on the Brighton and Hove Advocacy Partnership (BHAP) referral form.

Please contact Pohwer:

0300 456 2370

[email protected]

Online referral form

"*" indicates required fields

Date of Referral*

Has consent been given for this referral? (Verbal / Written / Other)*

Yes

If 'no' please indicate why

Person referred

Name:*

Address*

Home telephone:*

Mobile number:

Date of birth:*

Age:

Referred by:

Name:*

Referrer's Address*

Relationship to person being referred:*

Telephone:*

Email*

Please outline any support currently in place:

Does the person live alone?*

Yes

Please provide contact names and details for key people:

Such as family, social worker, support worker/key worker, GP, other.

First Contact Name:

Relationship:

Telephone:

Second Contact Name:

Relationship:

Telephone:

Reason for Referral:*

Are there any critical dates relating to this issue?

Does this person consider themselves to have a learning disability?*

Does the person have any communication/ access requirements?*

What is the best way to contact this person?

Risk Assessment: Are there any lone worker issues?*

Is there anyone else who can advocate for this person?*

Yes

You said 'yes'. Please give details:

Have you referred this person to any other advocacy services?*

Yes