Wellbeing groups referral form

To make a referral for yourself or someone else for our Wellbeing groups, please read the service member privacy notice then complete the online form. 

 

Service member privacy notice

Who we are 

We are Bradford District and Craven Mind, a local mental health charity, supporting people of all ages across Bradford District and Craven. We work in partnership with local authorities, the NHS and the voluntary and community sector.

To support you as best as we can, we process personal information about you and the people who help you, such as family, friends and professionals. We only do this to provide and improve our services, promote your wellbeing and keep everyone safe. We may use your information to:

  • Discuss how we can support you.
  • Assess your needs, plan, and provide you with support.
  • Monitor the effectiveness and fairness of our services.

Keeping your information safe

We store your information electronically in secure systems that can only be accessed by staff working across our services. In some services (and we will tell you if this is the case), we store your information on SystmOne; a digital NHS platform.

Sharing your information

We may share your information with trusted people involved in your life, such as health workers, social workers, youth workers, your parent/s or carer/s, the police or your school. Where possible, we will seek your permission before sharing, and we will not share against your wishes unless we are worried about your safety, or the safety of someone else.  

We may share your information in an anonymised form with our funders. We do not, and never will, sell your information for marketing purposes.

More information

If you would like to know more about how and why we process your information, the kinds of information we process, and what rights you have in relation to your personal information, please refer to the Privacy Policy on our website. Alternatively, you can request a copy in person or over the phone.

Phone: 01274 730815
Office: Kenburgh House, 28 Manor Row, Bradford, BD1 4QU
Email: admin@mindinbradford.org.uk

Wellbeing groups referral form

Please enable JavaScript in your browser to complete this form.
Your Full Name
Address
Which of the following methods can we use to contact you? Please tick all that apply.
Can we leave a voicemail?

If you’d like to keep up-to-date with our latest news and how you can get involved, sign up to our client mailing list. Your information will only be used to send out Bradford District and Craven Mind mailings.

Would you like to subscribe to our client mailing list?

Emergency contact details

Emergency contact details - Full name

Access and communication needs

Do you have any accessibility or communication needs that you would like us to be aware of? Please tick all that apply:

Sources of support

Risk management

We use risk information to ensure the safety of our groups whilst supporting as many people as possible to access our services.

Is there any reason you cannot or should not come into contact with children, young people or vulnerable adults?
Do you have any serious medical conditions we need to be aware of?
Are there any other risks we need to be aware of?
This includes risk to you (from yourself or from others) and risk to others from you (including staff and other people using our services).

Additional information

Do you have any caring responsibilities – for example, do you look after a relative, friend or neighbour who cannot manage without your help due to sickness, age or disability?

Main reason for seeking support (please state below)

Diversity monitoring

We use the information below to help us improve fair access to our services for all, and to understand if there are any groups we could be better at supporting. The information is collected for research purposes and will not affect your involvement with Bradford District and Craven Mind in any way. Summaries of demographic information may be shared with funders, but it will not include personal details and cannot be linked back to an individual. If you have any questions please contact us at admin@mindinbradford.org.uk

Religion
Gender
Sexual orientation
Do you consider yourself to be disabled, or to have a long-standing condition or illness that causes difficulty with day-to-day activities? By long-standing we mean that is has lasted or is expected to last at least 12 months. Tick all that apply.

Ethnicity

White
Asian / Asian British
Black / Black British
Mixed / Multiple
Other Ethnic Group

Please note, Wellbeing services are offered as group support only. Although your induction and any subsequent review will be done on a 1-1 basis, the regular support offer of the Wellbeing Service is group support. Our Wellbeing timetable is available on the Bradford District and Craven Mind website. Please be aware that this is not a 1-1 or Counselling service.

Full details on how we use your data and keep it safe can be found in our Privacy Policy.

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