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Client Details

GP details

Diversity Monitoring Data (optional)

GDPR/Data Protection Privacy Notice

Mind in Somerset collects, processes and stores the personal data in this form (and collected while we provide support) for three reasons only under the legal basis of provision of medical services. First, to contact you about your mental health and to arrange appointments. Secondly, to safeguard you and others and to provide case referrals to mental health partners in line with our legal obligations. Disclosure of your data may only be made to your GP, NHS bodies, your next of kin, statutory services, Compass Disability Services, or to other mental health professionals. Finally, we use anonymised data to monitor diversity and to provide statistics to those who fund and regulate us. Mind in Somerset may also share anonymised data with other local Mind associations or Mind. You have the right to request a copy of the data we hold on you by writing to us or emailing us. Complaints can be made in writing or by email by contacting us in the usual ways displayed on our web site. All data will be held for ten years from the date a referral is made and then deleted. 

All personal information will be added to our secure online database. The information you have provided to us will be kept strictly confidential.

Declaration by referrer (or person requiring service if self-referral)