Make a referral

If you support someone with inherited sight loss and they need additional support or information, you can make a referral to one or more of our dedicated services.

The services we offer include:

Information and support from our Helpline team either on the telephone or via email
Being paired with a somebody on our Talk and Support service
Access to our growing Local Peer Support groups and speciality interest groups
An assisted journey through our Discover Wellbeing programme
Speak to somebody with lived experience of Charles Bonnet Syndrome (CBS)

Our support is free and accessible.

More information about the information and support services we are offer can be found on the services page.

Make a referral

About you

Name(Required)

Prefix First Last

Organisation name(Required)

Phone

Email(Required)

About the person you are referring

The reason for referral to Retina UK (please detail support required if known)(Required)

What is your relationship to the person you are referring?(Required)

Full name of the person you are referring(Required)

Prefix First Last

Address(Required)

Street Address Address Line 2 Town / City County Postcode

Phone

Their communication needs

Please indicate how the individual should be contacted about the referral

Phone (voice call)

Text message

Comments

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