Referral page – 3rd Party – Citizens Advice Richmond

3rd Party Referrals

Please note, fields marked with the red asterisk are mandatory.

Use this service to refer someone to Citizens Advice Richmond.

You will need to share:

their name
a way of getting in touch with them
what help they need
their consent for their information to be shared with Citizens Advice

Fill in every field unless it says 'optional'. The more you can share the easier it will be for us to help them. Make sure only to share what you think is neccesarry.

We will make three attempts to contact the client. If the client does not respond, we will close the case and notify you.

Your Full Name *

Agency Name *

Agency password

As of August 2023 this password is now required. The rest of the form will appear once you enter the correct password.

Your Email address *

Your Telephone Number

I confirm the client below has given permission for this referral to be made, and for Citizens Advice to make contact with the client.

yes

Client's first name *

Client's surname *

Client's Date of Birth

Client's telephone number

Can we leave a message?

yes

Client's Email Address

Client's House Number/Name *

Client's postcode *

How would they like us to contact them? *

Mobile Phone Number

Home Phone Number

Brief outline of advice needed/referral reason *

Please include if possible the date the problem started, the last time the event occurred, etc.

Any specific considerations for this tenant (cannot come to office/difficulties making appointments etc.) *

File Upload

Maximum file size: 8.39MB

Do they consent to this referral?

I confirm that the person I am referring:
· is happy for the information entered in this form to be provided to Citizens Advice
· is aware that this information will be used by Citizens Advice for the purpose of providing them with advice
· has been made aware of Citizens Advice's privacy policy on the website.

I can confirm that the person being referred consents to the above *

Yes

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