Register for help from the Autism Berkshire Benefits Service

Thank you for your interest in getting support from the Autism Berkshire Benefits Service. Please can you answer some questions, so that we can help you.

Name

Address

Postcode

Telephone number

Email address

 

Which council area do you live in? *

—Please choose an option—Bracknell ForestReadingSloughWest BerkshireWindsor & MaidenheadWokinghamOther

If you answered Other above, please give the council name

 

Are you seeking advice about benefits for? (please tick all that apply) *

YourselfA member of your familySomeone you support as a carer/professional

 

Your age or the age of the person you are seeking support for:

 

Do you/the person you are seeking support for have? *

An autism diagnosisA place on an NHS waiting list for an autism assessmentNot have a diagnosis

 

Do you/the person you are seeking support for have? *

An ADHD diagnosisA diagnosis of another co-occurring condition, eg dyslexia or dyspraxiaA place on an NHS waiting list for an assessment for a co-occurring conditionNot have a co-occurring diagnosis

 

Message (if any)

 

I consent to Autism Berkshire storing my details on a secure database and contacting me about (please tick all that apply)

Benefits adviceSupport services for autistic adultsSupport services for families of autistic children and young people

 

I am happy to be contacted by (please tick all that apply):

EmailTelephonePost

Your confirmation:

I understand that by submitting this form I am giving Autism Berkshire consent to store my data and use it to contact me in the ways that I have indicated and for analysis and monitoring purposes.

 

Privacy and data protection

Personal information you submit using this form will be treated as confidential and stored securely. See our privacy policy for more information.