Please read these notes before completing this form:

You are encouraged to prepare some of your answers beforehand in a document and paste the text into the relevant boxes. If your internet connection is lost while completing the form, unfortunately you will have to start again.

Certain fields marked with a red asterisk * are always required. Any you omit will be outlined in red after you click the “Submit” button. After completing those fields, please click Submit again.

For professionals: if you are submitting a referral for support outside our normal contracts you will need to download, complete and send us an authorised Spot Purchase Form. Visit our Spot Purchases page for more information.

Referral Form

Click to Start an Online Referral in English

The online application form will be uploaded to
a secure server accessible by Dewis CIL.

Click to Start an Online Referral in Welsh

The online application form will be uploaded to
a secure server accessible by Dewis CIL.

Or you can download a referral form as a Word document

If you would prefer to submit a physical copy, you can download the form as a Microsoft Word document. Please click here to download the Referral Form in English or click here to download the Referral Form in Welsh. This should be printed out, completed and returned to us by post.