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Leeds Advocacy

Initial partner referral form

This form is intended for the points of view of a person with learning disabilities. Please answer the questions from their point of view. You can contact us if you need help.

About your referrer

The contact information of the person helping you fill out this form.

Your contact information

Please fill the following information with your details (the person being referred).

Can a confirmation letter be sent to above address to notify service user of this referral?


About you

Please fill the following information with your details (the person being referred).

Do you have Autism?


Is this a safeguard referral?


If yes, does the person understand and agree with the referral?


Where do you live?





About Leeds Advocacy

Leeds Advocacy is a voluntary, not-for-profit organisation set up to provide advocacy services for adults with a learning disability in the Leeds metropolitan area.

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