The Wellbeing Centre
139 Leighton Buzzard Road
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Please complete this form if you would like to access our services and we will contact you to discuss next steps. Please provide as much information as possible.
Please complete this section carefully. Supporting you to access the right services is very important to us but it isn't always easy to make contact, so listing as many contact options as possible will help us to help you more quickly.
Please confirm that you have the consent of the person for Herts Mind Network to contact in an emergency by ticking the checkbox below
(if completing the form on behalf of someone else)
Hertfordshire Mind Network adheres to the Data Protection Act 2018’s principles of good information handling and the EU General Data Protection Regulation 2018.
Your details will not be shared with anyone else without your consent. If you have any concerns or questions about how your personal data is collected and used, please ring us on 02037 273600 or email us at [email protected]. Please note that without your consent, you will not be able to submit this form and access Hertfordshire Mind Network’s services.
Where information is given in confidence that Hertfordshire Mind Network believes poses a risk to the client, a risk to other people, a risk to the safety and welfare of a child, or is against the law, we reserve the right to disclose that information to a relevant third party.
HYF Referral Form P1
Author: Clare Rennett
Posted on: 13th April 2022