Learning disabilities enquiry form Please complete the below form and our friendly enquiry team will be in touch. 1About you2Your enquiry Your first name* Your last name* Tell us who you are enquiring for*MyselfA loved oneA clientHow do you want us to contact you?*EmailPhone callText messageYour mobile phone numberYour landline phone numberYour email address* Age of person requiring support*Primary need*Brain Injury RehabBrain Injury Non-RehabAutismChallenging BehaviourComplex Healthcare – AdultComplex Healthcare – ChildDementiaDown’s SyndromeEpilepsyHuntington’s DiseaseLearning DisabilitiesMental HealthPhysical DisabilityPrader-Willi SyndromeGender of person requiring support*MaleFemaleTransgenderCounty where support is to be delivered*BedfordshireBerkshireBristolBuckinghamshireCambridgeshireCheshireCity of LondonCornwallCounty DurhamCumbriaDerbyshireDevonDorsetEast Riding of YorkshireEast SussexEssexGloucestershireGreater LondonGreater ManchesterHampshireHerefordshireHertfordshireIsle of WightKentLancashireLeicestershireLincolnshireMerseysideNorfolkNorth YorkshireNorthamptonshireNorthumberlandNottinghamshireOxfordshireRutlandShropshireSomersetSouth YorkshireStaffordshireSuffolkSurreyTyne and WearWarwickshireWest MidlandsWest SussexWest YorkshireWiltshireWorcestershireScotland, Aberdeen CityScotland, AberdeenshireScotland, AngusScotland, Argyll and ButeScotland, City of EdinburghScotland, ClackmannanshireScotland, Dumfries and GallowayScotland, Dundee CityScotland, East AyrshireScotland, East DunbartonshireScotland, East LothianScotland, East RenfrewshireScotland, FalkirkScotland, FifeScotland, Glasgow CityScotland, HighlandScotland, InverclydeScotland, MidlothianScotland, MorayScotland, Na h-Eileanan SiarScotland, North AyrshireScotland, North LanarkshireScotland, Orkney IslandsScotland, Perth and KinrossScotland, RenfrewshireScotland, Scottish BordersScotland, Shetland IslandsScotland, South AyrshireScotland, South LanarkshireScotland, StirlingScotland, West DunbartonshireScotland, West LothianWales, Blaenau GwentWales, BridgendWales, CaerphillyWales, CardiffWales, CarmarthenshireWales, CeredigionWales, ConwyWales, DenbighshireWales, FlintshireWales, GwyneddWales, Isle of AngleseyWales, Merthyr TydfilWales, MonmouthshireWales, Neath Port TalbotWales, NewportWales, PembrokeshireWales, PowysWales, Rhondda Cynon TafWales, SwanseaWales, TorfaenWales, Vale of GlamorganWales, WrexhamDo you have funding in place? Yes No Additional informationPlease share any further relevant information regarding your enquiry. Would you to receive our email newsletter?* Yes No You will receive email directly from Voyage Care with relevant information on our services. We will not share your data with third parties and you can unsubscribe at any time using the links in the email.
