Make a Referral – Request Advice for Someone Else

    If you would like to request advice from Citizens Advice, you will need to answer these questions first.

    Hull and East Riding Citizens Advice provide this service. We will treat all personal information as confidential and details will not be shared without consent, unless we are required to do so by Law. The information provided here will be used to make appointments only.

    If you wish to know more about our Data Protection and Privacy policy, please click here

    Are you requesting advice for a client or someone else?YesNo
    If you are requesting advice for yourself please use our personal form here

    We need your consent and that of your client to use some information, including ethnicity, religion, health conditions, sexual orientation and trade union membership. If you agree, we will use this information, which is known as 'special category personal data'.

    ***If you do not wish for us to store this information for use in both monitoring and in relation to your enquiry, please do not provide it***

    Before you continue, please confirm that you have the consent of the person you are referring for Hull and East Riding Citizens Advice to store the details of the person you are referring:

    We need your consent to record and use your special category personal data

    Special Category Information

    Please provide any special category data that they consent to us holding. If they do not consent to us storing their special category data, please select "Prefer Not to Say"


    Health Conditions

    Trade Union Membership

    Accessing our service

    Do they need an interpreter?YesNo
    If yes, what language do they need?
    The following 2 questions are asking for their special category data. Please ensure you have given us permission to store this in the section above.
    Do they have any communication needs?
    Do they have any mobility needs?

    Personal Details

    Do they live in Hull or East Riding Council Areas?HullEast Riding
    Do they have a registered home address?

    Their GP Surgery

    Are they a serving or former member of the armed forces?

    Armed Forces Details

    Are they...?

    In which service did they serve?

    What is/was their period of service?

    Were they medically discharged?

    Are they in receipt of...?

    Do we have permission to contact them via phone
    Do we have permission to contact them via email
    Do we have permission to contact them via letter
    Do we have permission to contact them via text
    Do we have permission to contact them via voicemail

    Main Reason for Referral

    Please tell us the reason they require support. (please select one option only)

    What is their household situation?

    What is their employment status?

    How are they housed?

    Have they been issued with...

    Do they have more or less than £75 spare monthly income, after all of normal expenses were met?

    Do they have any of these priority debts?

    Are you aware of any of the following urgent actions being taken against them?

    Please tell us about their issue. Please provide as much detail as possible in the text box below

    Do any of the below apply to them?

    Referrer Contact Details

    Referrer Name
    Referrer Email Address
    Referrer Phone Number
    Are you..?

    Are you from..?

    What is your organisation?>

    You are a...?

    Your Practice?

    You are a...?

    You work from:

    Please select:

    Please select:

    Please select:


    Can we contact you for your feedback on our service?

    If so, can we contact you via: