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Client Consent

In order to process this referral, we need to record details of your client. This will include ‘personal data’ (information which can be used to identify the client, such as their name, date of birth, contact details, etc.) and may include Special Category Data such as Health Conditions. We will discuss our use of the information further with the client when we first contact them. The information will be stored on a shared electronic case management system accessed only by members of the Citizen Advice service. To comply with data protection legislation, we must ensure there is consent from the client to record those details. To submit this form, you must have gained prior consent from the client to send us all the information you have provided below.

Referrer’s Details

If you have a referral partner code, put it here otherwise leave blank.

About Your Client

About Your Referral

Please provide some basic details about the referral and any information we should be aware of prior to contacting the client.
If you wish you may attach a document to provide us with further information. Please be aware this will not be encrypted when it is sent to us. Allowed file types: jpg, gif, png, pdf, doc, docx, xls, xlsx