Easy write Referral form

1
Easy write Referral form (What you want easy
write to do) Name of document you want to
refer Your name Date Email Telephone
number How did you find out about Easy
write? What is the document about? When does
the document have to be made easy to read
by?Please note it will take up to 2 weeks from
the date we receive your referral to allocate you
a mentor. Have you checked the Easy write
examples? Yes No Have you done the Easy write
training? Yes No Have you seen the Easy write
guidelines? Yes No You can find the above at
www.ldicn.org.uk under the Easy Write
pages. Signed Please
attach the document you will be working from or
any other information about the document. Return
to Ashleigh Burrows, Mansion House, Leicester
Frith Hospital Site, Groby Road, Leicester,LE3
9QF or email- ashleigh.burrows_at_leicspart.nhs.uk
or telephone [phone]