Wigwam Initial Enquiry Form
Please note:

- Wigwam is not an emergency service or a crisis response service (in cases of emergency please contact 999)
- Wigwam provides friendship, support and advice to families of children and young adults (under 25) with additional needs.
- Anyone can complete this Initial Enquiry Form including professionals, self-referrals and families
- Initial Enquiries are managed by our part time Family Support Worker, whilst we aim to respond as soon as possible please allow up to 10 days for a response from our Family Support Worker.

Email address
A) Your name
Your answer
B) Your telephone number
Your answer
C) Is this enquiry for your own family?
D) What are your reasons for contacting us? (examples may include...meeting other families/ need support/understanding my rights)
Your answer
E) When working with families Wigwam staff may make home visits, please note below if there is anything you feel would be useful for us to know if they were to visit you (examples may include.......dogs or other pets in the home/access issues/building work or other safety risks)
Your answer
F) At this point in time do you feel you would benefit from......
G) Name of parent/carer? (Note: If you are a family member you DO NOT need to answer any further questions)
Your answer
H) What is your role in relation to the family?
I) Has the family given you permission to contact us?
J) May we contact the parent/carer directly?
K) Telephone contact for parent/carer
Your answer
L) E mail contact for parent/carer
Your answer
M) When working with families Wigwam staff may make home visits, please note below if there is anything you feel would be useful for us to know if they were to visit the family (examples may include.......dogs or other pets in the home/access issues/building work or other safety risks)
Your answer
N) At this point in time do you feel the family would benefit from......
Please complete the captcha before submitting the form.
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