If you need any help with this form, you can call us on 020 7619 7139.
You need to get the person's consent before you apply for the service for them.
They need to be at least 16 years old to use the Working on Wellbeing service.
There is advice for disabled people looking for work and advice for disabled people in work on our website.
You can also call our helpline for advice on 0808 800 3333.
Working on Wellbeing is a service for disabled people.
Working on Wellbeing is only available to people living in Wales.
Support to Work is our national employment support programme. It is for disabled people in England and Wales who are looking for paid work.
Find out about Support to Work
There is advice for disabled people looking for work on our website.
Register for Working on Wellbeing
You need to be at least 16 years old to use the Working on Wellbeing service.