Support enquiries

Step 1 of 4

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Who needs support?(Required)

I’m looking for support for myself or a family member/friend

I represent a local authority looking for support for someone in my community

In which town/area is the support needed?(Required)

Your support needs

Please note: This is not an emergency support service.
If you need urgent help or advice, see this list of emergency phone and web helplines.

Type of support needed?(Required)

Autism

Learning disability

Mental health

Other

Please tell us more about the type of support needed(Required)

Level of support needed?(Required)

Support at your own home

Somewhere to live with someone to support you

To find a job

To access day activities

Other

Please tell us more about the level of support needed(Required)

Funding

Funding (local authority or personal budget) must be in place to access support.

Find out about local authority funding and whether you are eligible
If you are not eligible for local authority funding, you will need to pay for your care. Find out about self-funding your care

Do you have funding in place?(Required)

Eg a personal budget, direct payments or a care managed budget. Please note – we can only provide support for people with funding (see above information)

Yes

How can we help?(Required)

Please tell us more about your support needs.

Your contact details

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Telephone number(Required)

Mobile and/or landline

Where do you live?

City/town/village(Required)

County(Required)

Postcode(Required)

Your relationship to the person requiring support?(Required)

Eg father, mother, sibling, friend, support worker…

How we will use your information

Filling in this form helps us connect you with the right local team, who can provide the kind of support you need. Please include as much detail as you can. We endeavour to respond within five working days.

By completing and sending this form, you are consenting to be contacted by United Response staff using the details you give us.

We will never share the information you submit with any third party. But we may use your information internally to make sure we’re providing a good service.

Support enquiry form

Your support needs

Funding

Your contact details

Where do you live?

How we will use your information