Appointments

Tel: 0121 231 3195 (2 Snow Hill, Snow Hill Queensway,Birmingham. B4 6GA)
024 76 243 603 (The Quadrant Business Centre, Coventry CV1 2DY)

E-mail: admin@access-i.co.uk

Phone, E-mail or Complete this Form NOW for a DSA Needs Assessment within the next 2 days!

Fields marked with * are required.

Title*

First Name*

Surname*

Telephone number

E-mail address*

Correspondence Address*

Preferred method of contact to book the appointment*

Funding Body*

Customer Reference Number*

Please attach the Funding Body Letter (if available)

Nature of Disability*

Details

Please attach the Diagnostic Letter/ Report (if available)

University / College*

Course*

Level*

Year of study*

Preferred Needs Assessment Venue*

Do you have a preferred day or time to attend a Needs Assessment*

Any other relevant Information

We will now process this form and will contact you to book an assessment with an Assessor who specialises in your particular condition

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Appointments available tomorrow!