If contacting a helpline isn’t for you



We have included the option to contact us via an online referral form. We have three referral forms for you to use. Which one you use depends on who you are, as you may be an autistic individual, a parent or carer, a professional or a third party. Please check the description above each referral form to find out which is the most suitable for you to complete.

Once you have completed the form, please click ‘submit’ and your form will find it’s way to one of the team. We will then look into your enquiry ad contact you once we have sourced the requisite information or support.


خود حوالہ فارم

کیریئر / پیرنٹ ریفرل فارم

پیشہ ور / تھرڈ پارٹی
حوالہ فارم

Before completing this referral form, please note the following: this referral form is for completion by a professional or third party affiliated with an autistic individual enquiring about support for خود. If you wish to enquire about support for someone else, please telephone our helpline. 

If you are a professional seeking training or awareness raising relating to autism to be implemented in your own organisation or service, please contact our service via the enquiries box or email address provided, detailing your requirements. 

All the following sections must be completed if possible:

کیا آپ جس فرد سے رابطے میں ہیں اسے ASC کی باضابطہ تشخیص ہے؟ براہ کرم مندرجہ ذیل میں سے ایک کو منتخب کریں:

Tick the box below to confirm the person who requires support lives in Derby/Derbyshire?

ہم سے آپ سے رابطہ کرنے پر رضامندی کے لئے نیچے دیئے گئے باکس پر نشان لگائیں:

3 + 9 =