Refer someone for RNIB Services

This form is for professionals working with people affected by sight loss, and looking for extra support.

Other ways to contact us

● Advice and support for you - or someone with an eye condition you’re supporting

● Business services - help ensure that your business is inclusive

We aim to contact the person referred within two working days.

Fields marked * are required.

Consent * Please confirm you have gained consent from the person you are contacting us about to make this referral. If you haven't, we won’t be able to follow up on this referral.

Yes

Your details

First name *

Surname *

Your email *

Your phone number (optional)

Enter a UK phone number (e.g. 0121 234 5678) or a number with an international call prefix.

Organisation name *

Sector (optional)

Person being referred

Their first name *

Their surname *

Their email (optional)

Their phone number *

Enter a UK phone number (e.g. 0121 234 5678) or a number with an international call prefix.

Their date of birth (optional)

Day

Month

Year

Address line 1 *

We use this information to signpost to local services in their area.

Address line 2 (optional)

Town (optional)

Postcode *

Sight status (optional)

Referral Reason

Referral type (optional) Please select all relevant options.

Eye health - such as conditions, care services or registering as sight impaired

Practical support - such as employment, money & benefits, keeping active or living independently

Emotional support - such as counselling or support groups

Referral details *

Please explain as fully as possible to help our team offer the right support.

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