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      Support request

      Please fill in this form if you or someone else is looking for care and support. After we receive this form we will contact you within 2 working days to talk about what you or the person you are enquiring for need in more detail.

      About you
      Your details
      Information on support needed

      Your information

      How we will use your information

      • Action on Hearing Loss will securely store all information provided and will not share this with any third party.
      • Information provided by you will be used to help us give you relevant information and identify support that we may be able to offer.
      • Action on Hearing Loss will not use or store personal data without consent either from individual or a person acting on their behalf.

      Your rights

      You have the right to withdraw consent at any time and request for all information to be deleted. By submitting this form you are confirming to consent to sharing the personal information on this form with us for the purposes of an initial enquiry to our Care Services.

      If you would like more information on how we collect, hold and use personal information please our view our Privacy Policy