Autism Hub Midlands – 1:1 support Are you a family member, informal carer or personal assistant of an autistic person? We’re delighted to be offering individual sessions on autism education, information and guidance as well as regular online group sessions. To find out more, visit the Autism Central website. Book an appointment To book a free 30-minute call, please select a date and time below. All our calls and sessions are delivered by people with lived experience of autism. If you cannot find a suitable time, please email autismhubmidlands@contact.org.uk Prefer an email response? Alternatively, you can get support via our email service – simply complete the form and one of our Peer Educators will get in touch with you via email. Autism Hub Midlands – book an appointment "*" indicates required fields Please select a date*ABOUT YOUName* First name Last name Email* Enter email address Confirm email address Phone number* Please confirm phone number To ensure we have the correct number to call you on, please retype your phone number in the box below. Please do not copy and paste from the above field.Confirm phone number* 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 INFOCan a message be left?* Yes – you can leave voicemail Yes – you can leave message with someone No – do not leave voicemail or message with someone Please 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 to be discussed*Accessibility If you have any accessibility needs regarding the appointment, please contact AutismPeerEducatorHub@contact.org.uk as early as possible. 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, we will have this information. If you haven’t had a Autism Hub appointment, tick “no” below and we’ll take you to the next stage. Have you previously had an Autism Hub appointment? 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