Autism Hub for families in the Midlands – email support Are you a family member, informal carer or personal assistant of an autistic person? Do you live in the Midlands? We’re delighted to be offering email support, individual sessions on autism education, information and guidance as well as regular online group sessions. Get in touch Complete the form below and one of our Peer Educators will email you back. If you’d prefer a 30 minute phone appointment, visit our appointment booking pages Book an Autism Hub Midlands 1:1 support appointment > "*" indicates required fields ABOUT YOUDo you live in the Midlands or London?* London Midlands I don’t live in the Midlands or London If you don’t live in the Midlands or London Contact is part of Autism Central, and together with Ambitious about Autism, we run the London and Midlands hubs. Autism Central is a project that provides parents and carers of autistic people with autism education, training and support in regional hubs across England. If you live outside London or the Midlands, you can find local support on the Autism Central websiteIf you live in London Please complete the form on this page: contact.org.uk/autism-hub-london-email-serviceName* First name Last name Email* Enter email address Confirm email address Phone* Postcode* Personal characteristicsProviding information about personal characteristics is voluntary; it will be used to ensure we are reaching people from all communities, and to help us to address the needs of different community groups.What is your gender?Please selectMaleFemalePrefer not to sayPrefer to self describeYour ethnicityPlease selectAsian / Asian UK: BangladeshiAsian / Asian UK: ChineseAsian / Asian UK: IndianAsian / Asian UK: PakistaniAsian / Asian UK: Any other Asian backgroundBlack / African / Caribbean / Black UK: AfricanBlack / African / Caribbean / Black UK: CaribbeanBlack / African / Caribbean / Black UK: Other backgroundMixed / multiple ethnicity: White & AsianMixed / multiple ethnicity: White & Black AfricanMixed / multiple ethnicity: White & Black CaribbeanMixed / multiple ethnicity: Any other originWhite: English / Scottish / Welsh / Northern Irish / UKWhite: IrishWhite: Gypsy or Irish TravellerWhite: Any other White backgroundOther ethnic group: ArabAny Other OriginPrefer not to answerDo you identify as neurodivergent?Please selectYesNoPrefer not to sayADDITIONAL INFOPlease provide information about the autistic person / people you are supporting. This could include their age, gender and ethnicity as well as information about their condition and challenges.*Key issues you'd like support on*Keep in touch We’d like to keep in touch with you about our latest news and updates. We will look after your details in accordance with our data protection policy, and we will only ever contact you in the way you want us to. Read more about what you’ll receive if you opt into our updates.I agree to my data being processed as outlined above* Yes I'd like to receive news updates from Contact via email* Yes No More about youTo ensure you have the best experience, we’d like to know a bit more about you. If you’ve previously had an Autism Hub appointment or used our email service, we will have this information. If you haven’t had an Autism Hub appointment or used the email response service, tick “no” below and we’ll take you to the next stage. Have you previously had an Autism Hub appointment or used our email service? Yes No Address Line 1* Address Line 2 Town/City* Age group of your autistic family member Early years (0-4) Primary (5-11) Secondary (11-17) Young adult (18-24) Adult (25-64) Older adult (65+) Prefer not to say Is English your main language? Yes No Prefer not to say Does your household receive any means-tested benefits? Yes No Prefer not to say CAPTCHA