Get Assistance

Please complete this form using the details of the individual that requires assistance. If you are referring on behalf of someone else, please add your name, where you are referring from (e.g. NHS surgery name) and your contact details in the message box.

Assistance Required
We communicate with our service users by email, telephone, text and letter (which will be sent to the address supplied on this referral form). “I am happy for HUMAN-US to communicate with me in the following ways":

HUMAN-US is committed to maintaining service user confidentiality. All information about you is held securely. We will never sell or share your personal information except with trusted partners who work with us or on our behalf to deliver our services.