Information and support

Are you looking for advice for yourself or for someone else?(Required)

For myself

For someone else

Until clearly stated otherwise, all following questions will be addressed to the person you're completing this on behalf of. Please answer from their perspective rather than your own.(Required)

I understand

You must have the permission of the person you're completing this on behalf of(Required)

I confirm that I have the permission to complete this form on behalf of someone else

Do you have a long-term illness or disability, or do you look after someone who has?(Required)

Yes

No

Would you, or someone who normally helps you, be able to contact the relevant organisations and make applications if you had the right information?(Required)

Yes

No

Are you, or a partner that you live with under State Pension age?(Required)

If you’re unsure, you can check your State Pension age online

Yes

No

Does someone who needs help because of their illness, frailty, disability, a mental health problem or an addiction rely on you for support?(Required)

Yes

No

Are you worried about money or paying bills?(Required)

Yes

No

Do you have an illness or disability and wonder if there are any benefits to help pay for support?(Required)

This can include a range of medical conditions including behavioural and mental health conditions, learning disabilities and developmental delay.

Yes

No

Do you care for someone who has an illness or disability and wonder if there are any benefits to help pay for support?(Required)

This can include a range of medical conditions including behavioural and mental health conditions, learning disabilities and developmental delay.

Yes

No

Do you care for someone and need options to help manage their affairs?(Required)

Yes

No

Have you had a letter (often called a ‘migration letter’) saying you have to change from the benefit you've been getting to Universal Credit?(Required)

Yes

No

Would you also like to receive your personalised information and advice by email?(Required)

Yes

No

Email(Required)

We will only use this email to send the document generated from your answers on this website. The document will not contain any personally identifiable information.

The questions on upcoming pages will ask for personal details.

We are collecting these details to create a referral to the Oxfordshire Advice Partnership. The referral will be assessed and then assigned to the Oxfordshire Advice Partnership member organisation that will be able to best support you.

Reminder: Please input the details of the person you are completing this form on behalf of. We will ask for your details at the end.

Name(Required)

First Last

Date of birth

National Insurance number (if known)

Address(Required)

Street Address City Post code

Email

Phone number(Required)

Do you live alone?(Required)

Yes

No

Who do you live with?(Required)

What in particular would you like support with?(Required)

Is there anything that needs to be dealt with urgently?(Required)

Do you have any health problems or concerns?(Required)

Do you currently receive any benefits or have any specific financial issues?(Required)

Are you being supported by other individuals or organisations?(Required)

You must ensure that the person you’re completing this form for understands these consent statements.

The Oxfordshire Advice Navigator is provided by the Oxfordshire Advice Partnership which brings together a number of local advice agencies.

Data storage and processing consent(Required)

I consent to this referral to the Oxfordshire Advice Partnership and for the service to store and process the personal and sensitive (e.g health) details on this form.

Data sharing consent(Required)

I consent to the sharing of these details with partner agencies and to those agencies contacting me by phone/post/email/voicemail to progress my case.

Contact consent(Required)

I consent to partners contacting the contact(s) named on this form about the details I’ve shared.

Without explicit consent, we cannot process this referral

We now need the details of the person completing this form.

My name(Required)

First Last

My phone number(Required)

My email(Required)

Who should we contact?(Required)

Me

The person I’m applying on behalf of

My relationship to the person I'm applying on behalf of(Required)

A summary of your answers:

{all_fields:exclude[50,94,97,98,103]}

Phone

This field is for validation purposes and should be left unchanged.