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Address

Fyber Agency
Realtex House
2 Leeds Road
Rawdon
LS19 6AX

Phone & Email

Ask us!

    Referrals

    Home / Referrals form

    If you need any support referring to us you can call us on 01274 065 060

    Please read:

    Bradford Dementia Hub is delivered through a partnership between Community Links and Khidmat Centres, therefore there may be occasions your information must be shared between these 2 services.

    We may need to share information with other professionals where your support and safety is a priority.

    This will only be on a need to know basis, relevant information and only when necessary. We will always work to speak to you prior to sharing information. All information processing and storage is secure and in line with the Data Protection Act (1998) and General Data Protection Act 2018 (UK GDPR).

    Print Referral Form

      I am:*

      First Name*

      Last Name*

      Date of Birth*

      Phone Number*

      Address*

      Post Code*

      GP Surgery*

      Phone Number*


      If you have a diagnosis, please state the type of dementia

      Other:


      How do you prefer to be contacted?*


      Do you need any support with communication?

      Other:


      Is there anything we should be aware of before contacting you?

      Equal Opportunities Questions

      The data will be held securely and will be used anonymously to ensure we are providing a fair and accessible service.

      Gender

      Ethnicity

      Sexuality

      Religion

      Where did you hear about us?

      Other: