Refer someone for RNIB Services

We are RNIB, one of the largest sight loss charities offering practical and emotional support to people affected by sight loss. If you are a professional working with people affected by sight loss, and looking for extra support, please enter the referral details below and we'll be in touch.

Please ensure you have the consent of the individual to share their details with us and complete the "Referral Reason" as fully as possible to help our team offer the right support.

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

Fields marked * are required.

Your details

Name *

Profession *

Organisation name *

Organisation Address

Address line 1 *

Address line 2 (optional)

Town/City *

Country (optional)

Postcode *

Phone number *

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

Email address (optional)

Detailed of person being referred

First name *

Last name *

Date of birth *

Day

Month

Year

Their address

Their address line 1 *

Their address line 2 (optional)

Their town/city *

Their country (optional)

Their postcode *

Their contact details

Their phone number *

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

Their email address (optional)

Consent

Please confirm you have gained their consent to make this referral? * If you haven't gained their consent we will not be able to follow up on this referral.

Yes

Referral Reason

What is the reason for this referral? *

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

Appearance

Appearance

Refer someone for RNIB Services

Your details

Name *

Profession *

Organisation name *

Organisation Address

Address line 1 *

Address line 2 (optional)

Town/City *

Country (optional)

Postcode *

Phone number *

Email address (optional)

Detailed of person being referred

First name *

Last name *

Their address

Their address line 1 *

Their address line 2 (optional)

Their town/city *

Their country (optional)

Their postcode *

Their contact details

Their phone number *

Their email address (optional)

Consent

Referral Reason

What is the reason for this referral? *

Refer someone for RNIB Services

Your details

Name *

Profession *

Organisation name *

Organisation Address

Address line 1 *

Address line 2 (optional)

Town/City *

Country (optional)

Postcode *

Phone number *

Email address (optional)

Detailed of person being referred

First name *

Last name *

Their address

Their address line 1 *

Their address line 2 (optional)

Their town/city *

Their country (optional)

Their postcode *

Their contact details

Their phone number *

Their email address (optional)

Consent

Referral Reason

What is the reason for this referral? *

Can we keep you up to date?