Adviceline 0808 278 7930 (Monday to Friday 10am - 4pm)

  • Partner referral

    This referral form is only for third party agencies referring clients to us.

We will be unable to reply if this form is completed by the person seeking advice. For individuals seeking advice please complete our email us form.

To refer a client to us, please complete the form below. We respond to referrals Monday to Friday (closed on public holidays), and aim to get back to the client within 5 working days.

Everything you tell us will be treated in absolute confidence. See our Privacy Policy for more information.

Partner referral form

Client Referral

Referring agency details

Client details

Can we leave message?
Can we email you?
Is the client receiving welfare benefits?
Please tick preference for CAMV appointment:

About the issue

If you have provided information about your client's ethnicity, health condition, religion, sexual orientation and/or trade union membership in the 'brief details of the issue' question above, we need your client's explicit consent to record these details.

Please confirm your client is happy for details of their ethnicity to be recorded
Please confirm your client is happy for details of their health condition to be recorded
Long term health problems?
Please confirm your client is happy for details of their disability to be recorded
Disability
Please confirm your client is happy for details of their religion to be recorded
Please confirm your client is happy for details of their sexual orientation to be recorded
Please confirm your client is happy for details of their trade union membership to be recorded
Does your client belong to a union?

Client consent to data collection

I agree that the information given above can be shared with Citizens Advice Mole Valley (CAMV). I understand that CAMV will only use this information to help with my enquiry, only access it when they have good reason and won’t sell it to any commercial organisations.

Consent statement read to client and client has given verbal agreement