Make a Referral

If you are working with an eligible person from Hong Kong? If so and you would like to refer them to the scheme, please complete the form below:

Your Details

Referral Organisation Name

Referral Organisation Address

Referrer First Name

Referrer Surname

Referrer Job Title

Referrer Email

Referrer Phone number

Service User First name

Service User Surname

Service User Email

Service User Phone number

Service User Address

How would the service user like us to contact them?

By text

By phone

By email

If the service user would like to receive a phone call, will they require an interpreter?

Yes

When would they like us to contact them?

Please input additional information here

By contacting us, you agree to our Privacy Policy and Terms of Use.