LGBT Foundation Services - Self Referral Form
Please complete the form below to access our wide range of wellbeing services. Once you have submitted this form, we will invite you to our building for an assessment. All of our services are free at the point of care and we are here if you need us.
We understand that confidentiality is important to our service users. The information that you share with us will be kept in the strictest confidence and in accordance with the Data Protection Act (1998). During the Intake and Assessment meeting, a member of the Services Team will explain to the service user the exceptional circumstances when confidential information will have to be shared, for example, if they or somebody else is at risk of significant harm or where there is a requirement in law in the case of serious criminal offences (in particular terrorism and money laundering). In such exceptional circumstances, we will try to get their consent before disclosing any information if that is possible and do our best to help them. For further info on our policy please contact us at 0345 3 30 30 30.
By completing this form and clicking 'submit' below, I understand and agree to the following;
LGBT Foundation will collect information about you and the care you receive, this includes your referral form, assessments notes, paperwork related to the services that you access and correspondence related to your care.
My information will either be stored in paper form and/or in electronic records. All data that is collected is subject to the strict rules of confidentiality laid down by Acts of Parliament, including the Data Protection Act 1998, the Health and Social Care Act 2001.
LGBT Foundation may also get information about me from certain other organisations or give information about me to them: to make sure the information is accurate: prevent or detect crime or significant risk: and protect public funds. These organisations include local authorities, the police and or other healthcare professional