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OTR Referral Form

We offer a walk-in service from 9:00 am to 4:30 pm, including booked appointments. To book an appointment please call 01744 646 473.
We offer a walk-in service from 9:00 am to 4:30 pm, including booked appointments. To book an appointment please call 01744 646 473.
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What agency are you from?

What is your name and job title?

Address

Do you know the young person’s pronouns?

What is their full preferred name?

What school or college do they attend?

What day is best to contact them?

What time is best to contact them?

What is their contact number?

What is their email address?

How do they describe their gender identity?

Is their gender identity different from the sex they were assigned at birth?

How do they describe their sexuality?

Why would they like to join the group?

Would your organisation like any further training regarding LGBT?