Referral – Swindon Citizens Advice

We accept referrals from all legitimate local and national agencies. Please complete the form below ensuring you have your client’s permission to share their information with us for assistance.

Your Details

Let us know how to get back to you.

Your first name: *

Your last name: *

Who do you work for: *

Your telephone number:

Your email address: *

Client Details

Please remember to provide at least one way to contact the client.

Client first name: *

Client last name: *

Client address:

Client telephone number:

Client email address:

Preferred contact time/method?

How can we help the client?

Please tell us a little about the case by completing the below.

Please briefly describe the primary issue you would like us to look at? *

Please add any additional information to help us allocate the right help for the client (e.g. literacy or language barriers, digital help, physical or mental health problems):

Please set out below any time limits involved in this case and cause:

Is the client in dispute with another individual? *

*If yes, we will need to contact you for more information before we proceed with the referral.

Has the client presented any behaviour that is contrary to the well-being of staff? *

**If yes, we will need to contact you for more information before we proceed with the referral.

Please confirm the client is aware of and has agreed to this referral? *

***If no, we cannot accept referrals without the clients knowledge or agreement. Please speak to the client then complete this form.

Would you like to know the outcome of this referral?

We will ask the clients permission to provide feed back to you.

I agree for Citizens Advice Swindon to store the information I have provided in accordance with their privacy policy. *