Provider request form

Enable-Solihull is a user-led pan-disability organisation providing information and guidance for disabled people and carers as well as guidance to those providing a wide range of services. It represents both service users and care and support organisations at a strategic level through membership of key Partnership Boards and committees.

If you would like to have your service or provision listed then please fill in the request form below.

Please ensure that you enter information into each box. If you have no information to enter then please put N/A. Alternatively you can email us direct at kay@enable-solihull.org.uk:

Name of Organisation:

Description of services provided:

Address:

Phone Number:

Website:

E-mail:

Rates (please provide details if appropriate):

Are you commissioned?:

Are you regulated by a recognised body? (Y/N – please provide details):

Any other Information you wish to be included?:

Your name:

Todays date:

Now