Harborough Referral Form This referral will be sent directly to Harborough branch. Please enable JavaScript in your browser to complete this form.Referring organisation *Name of referring organisation and departmentContact name *Name of staff member making this referralEmail address *Telephone numberDate of referral *Client name *Client addressClient postcode *Client telephone *Client email addressCan we send a text or leave a message on client's phone? *Yes, send a textYes, leave a messageNo, don't send a text or leave a messageHas the client given verbal consent for this referral to be made? *YesNoHas the client given verbal consent for their details to be passed to Citizens Advice LeicesterShire to allow us to contact them?Has the client given verbal consent to discuss their case? *YesNoHas the client given verbal consent for Citizens Advice LeicesterShire to discuss their case fully with the referring organisation?Reason for referral *Debt advice and assistanceHelp to Claim universal creditMacmillan welfare benefits for those affected by cancerGeneral benefits advice and assistanceBudgeting adviceEmploymentHousingOtherSupplementary informationPlease use this space to give any further information about the issue, including any action already taken, any deadlines or other relevant informationPhoneSubmit