If you feel like you or someone you know* would benefit from one of our services please fill out our referral form. All information is treated with confidence and will not be passed on to third parties. If you require further information on any of our services or the referral process please email firstname.lastname@example.org
If you are making a referral to The DEN (Children's IDVA Service) please click here to complete the referral form.
*if you are completing a referral on behalf of someone else then they must be aware you have submitted their details to Blackpool Advocacy.
PLEASE NOTE: You or the person you are referring must be a Blackpool resident to access all of our services. We also cannot accept referrals for any of our services regarding the following issues:
If you are referring yourself please enter your details in the following boxes. If you are referring someone else please enter their details. Do not enter your details here if you are not the one who would like to access our services ie. carers or professionals.
Please provide at least one telephone number so that we are able to contact you/this person.
Please note any possible risks that our staff may occur if they go and visit you/this person e.g. pets, smoking, drug/alcohol abuse, past violence etc.
If you are filling this form for yourself please type 'Self' in the following boxes. If you are a professional or family member completing this form for someone else please enter your details.
Please give as much detail as possible as to why you/this person would like to access one of our services. Please make sure you understand what you can access from our services before you make the referral. If you have any meetings you would like us to attend please give details of these too. Also if you are making a referral for yourself and have a social worker please provide their name and contact number if possible.