If you need any help with this form, you can call us on 0808 800 3333.
You must answer all the questions marked with an asterisk (*).
Sleep Right may not be suitable for you. If you’d like to discuss this with us, please complete this application and we'll contact you.
Sleep Right is for parents of disabled children or children with additional needs. Your child does not need to have a medical diagnosis.
To use this service we’d like to contact you by phone and by email before arranging a face to face meeting. Please tell us if you have any access requirements.
We will not use your details for marketing or fundraising.