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Please complete the disability discrimination form below outlining how you were discriminated against because of your disability. If you have received less favourable treatment because of your disability or your employer has failed to make reasonable adjustments for your disability, you may have an disability discrimination employment tribunal claim.

You do not have to be registered disabled to make a disability discrimination claim and disability includes 'hidden' disabilities such as depression, asthma, diabetes, dyselxia, anxiety and panic disorders and ME amongst others.

If you would prefer to speak to one of our employment law specialist solicitors and lawyers in confidence to discuss your disability discrimination, please phone 0800 3899 096.

Personal Details

First name ^*

Surname ^*

Address

Telephone number

Best time to call?

Email address ^*

Date of birth (dd/mm/yyyy)

Are you registered disabled, or do you consider yourself as having a disability, whether physical or mental? Yes
No

Discrimination Details

In what way do you believe that you have been discriminated against on the basis of your disability? ^*

When did the last act of discrimination occur? ^*

At any point did you make a request of your employer to make adjustments to your work premises or your conditions of work? Yes
No

If so, when and was the request granted or rejected?

Have you raised a grievance in relation to the discrimination that you believe you have suffered? Yes
No

Have you already commenced Tribunal proceedings? Yes
No

Please ensure that you have completed all the required fields (marked with *) and then click submit to send the form.

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