Advice enquiry form

You can use this form to send us an enquiry rather than phoning us. Lines can be busy, so you might prefer to fill in this form. (Fields marked with a * must be completed.)

Please include the area of Coventry where you live. Please note that we are only able to offer help to people who live in Coventry.
Please enter in the format DD/MM/YYYY - for example 25/05/1995
Please choose from the dropdown menu. This helps us monitor how well our service is reaching different groups and to make changes where necessary.
Please give enough information to help us understand the problem you have. Our adviser may then be able to answer your question straight away or may be able to send you some information that can help. If we can't help straight away, our adviser will contact you to discuss the problem further.
If we are not able to leave a message for you, please add a note to the enquiry box above.
We will try and make contact at your preferred time, but this may not always be possible. If you are concerned about being contacted at any time, please let us know by adding a note to the enquiry box above.
If you are making a referral, please confirm that the person named above has agreed to this referral before submitting. If you are unsure if a referral to our service is appropriate, please contact us first.
Please tick all the statements above that apply. We have a legitimate interest in recording some information about you to help with your enquiry. We will keep all your information safe in our secure case management system (AdvicePro). An information sheet can be provided on request which gives more information about how we use and store your data.