Application Form

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  4. Application Form

How to join a group / make a referral

We operate an open application system. This means that you can complete an application form if you are:

  • a person with aphasia
  • a relative
  • a friend
  • a healthcare professional
  • other

We ask you to complete the form and send it to us by:

Email: info@aphasiareconnect.org, or

Post to: Aphasia Re-Connect

17 Elm Road,

Beckenham,

Kent BR3 4JB

Download an Application Form here:Download

For help or more information: Contact Us