You can contact our helpline service via telephone on 01462 454986 (Monday to Friday 9.00am-1.00pm). Alternatively please fill in our online form below. * Indicates required fields Email the Helpline Service - v2 In order to fully monitor the helpline service; ensure we are reaching as wide a group as possible and meet the requirements of our funders we need to ask you a few questions. Step 1 of 3 - About the Caller 33% TitlePlease selectMrMissMrsMsDrOtherOther - please stateName* First Last Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Telephone Number*Email* Enter Email Confirm Email Are you a*Please selectParentRelative/CarerAdult with DyspraxiaProfessionalOtherOther - please specifyHave you contacted us before?* Yes No Are you a member of the Dyspraxia Foundation?* Yes No Is the enquiry about:*YouSomone ElseAre you/they - Gender* Male Female How old are you/they?* Primary 0 - 9 Years Secondary 10 - 15 years Post 16 years Aged between 18 and 25 years Aged between 26 and 64 years Aged 65+ Do you consider yourself/them to have a disability?* Yes No Ethnic BackgroundWhitePlease selectEnglish/Scottish/Welsh/Northern Irish/UKIrishGypsy or Irish TravellerAny other white backgroundAsian/Asian UKPlease selectIndianPakistaniBangladeshiChineseOther Asian backgroundBlack/African/Caribbean/Black UKPlease selectAfricanCaribbeanOther black/African/Caribbean backgroundAlternative Ethnic options Mixed Ethnic race Arab Any other Ethnic group Would rather not say Do you/they have a diagnosis of dyspraxia?* Yes No Reason for Enquiry* Diagnosis Health Education Employment Emotional Support Benefits or Money Other - please state below… Outline of enquiry (there is a maximum of 1000 characters)We hope you will find the information and advice useful. We would like to follow up your enquiry in the future to help ensure our service is making a difference. Would you agree to us contacting you to see if the advice was useful and made a difference to your situation during the next 12 months?Enquiry follow up* Yes No CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.