Online Request Form – Legal Entitlements and Problem-Solving (LEaP) Project Cerebra > Help and Information > Law and Rights > Ask for help from our Legal Entitlements and Problem-Solving (LEaP) Project > Online Request Form – Legal Entitlements and Problem-Solving (LEaP) Project If you would like to ask for support from the Project, please read our Guidelines first and then complete the form below. If you have any questions, you can contact us at firstname.lastname@example.org or on 01267 242582. Title * Mr Mrs Miss Ms Dr Forenames * Surname * Address * Postcode * Email Address * Phone Number * Please enter your area code and phone number without spaces Your Child's Details Full Name * Date of Birth * Please enter as dd/mm/yyyy e.g. 21/12/1956 Medical Conditions * Your Concerns Name of relevant local authority or NHS body * What do you think they did wrong or failed to do? * Describe how your family has been affected * What do you think should be done by the relevant authority to put things right? * Have you raised your concern with the relevant body? If so, how and when did you contact the authority and what was its response? * In order for us to process your request for a referral to the Legal Entitlements and Problem-Solving Project, we will store your details electronically and anonymised data may be used for research purposes connected to the Project. We respect your right to privacy and will keep safe any personal details that you give us in line with the UK Legislation on Data Protection. We will securely store the data you enter and only use it for the above purposes. We do not sell or share any information with third parties. Please indicate that you are happy for us to store and process your information in this way. Without your consent we will be unable to proceed with your enquiry. Agree * Yes Are you human?