Privacy Notice: Referral Form

The GDPR provides individuals 8 limited rights:

• Right to be informed,
• Right to access their information held
• Right to rectification of incorrect information
• Right to be forgotten
• Right to restrict processing
• Right to data portability
• Right to object to processing
• And rights in relation to automated decision making and profiling

Please see the data protection policy for details.

By sharing information you are consenting to the processing of that information.
All information provided may be shared between the counselling, one to one, and/or admin teams as required.

To be able to access these services we need address or telephone to be able to contact you, age to ensure eligibility to the service, and risk factors for safeguarding.

You have the right to withdraw consent of this information at any point, however please see below for the consequences of this action. If at any point you’d like to lodge any complaint regarding the use of data, please don’t hesitate to contact the Data Protection Officer.

All data provided will be retained for a specific period of time after the end of a project.
You will need to ask a staff member for exactly how long that would be as it varies by funder.

	Purpose	Compulsory information?	What happens if you refuse?
Name	Required to identify application	No	Can’t be referred
Address	Required to inform applicant of written information	No	Either address or telephone must be given to be referred
Telephone	Required to contact applicant re. appointments	No	Either address or telephone must be given to be referred
Email	Alternative contact option	No	None
D.O.B.	Identification, safeguarding, and ensuring minimum age for service	No	Can’t be referred
ICE Contact	Reach contact in emergency	No	None
Referred to	Required for client allocation	No	None
Self-Disclosed Problems/Needs	Required for client allocation	No	None
Self-Disclosed Risk Factors	Required for risk assessment	No	Can’t be referred
Additional Support	Knowing this allows us to avoid duplicating work with other organisations	No	None