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Third party referral form

Please ensure you have the consent of the child’s parent or the young person to share their details.

Our services are for children and young people who are:

  • Deaf*
  • Aged 0-25
  • Based in the UK, and
  • Need support with a deaf related issue

*We use the term ‘deaf’ to refer to all types of hearing loss from mild to profound. This includes deafness in one ear or temporary hearing loss such as glue ear.

Complete the following so we can start the referral process.

Mandatory fields are identified by the asterisk character (*)