Wellbeing and Emotional Support Teams - self-referral form

Any information provided within this form is strictly confidential.

The only time we will share information is on occasions where you, the young person has asked for your information to be shared, or when if you have given permission following a request for information.

In instances, where we believe a you or another young person to be at risk, we may share the necessary information without prior consent.

Herefordshire and Worcestershire Health and Care NHS Trust is required to comply with the laws and regulations that apply to protecting your data and how it is used. They are the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018.

In our  Privacy Notice  we will explain how we collect, use, store and protect your personal information. We will also explain what rights you have with regards to your personal information and how you can exercise those rights.

Young Person Personal Details

Note: Questions marked by * are mandatory

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