Referral Form

*Please complete all mandatory fields to access our free services.

Click to see what services are available for Adults

Equalities monitoring questions are anonymised and analysed statistically to help us and our funders understand the extent to which our clients represent the local community we serve.

Ethnic Origin

Religion and Belief

Gender

Sexual Orientation

Health Conditions and Disability

Employment

Financial Situation

Any personal information you share with Richmond Borough Mind will be kept secure and used in line with the General Data Protection Regulation 2018 (GDPR). We may also make contact with other people supporting your mental health to discuss your referral. This information will only be used to assess your needs and the services that you may benefit from. Information about you will be kept confidential and will not be disclosed to third parties without your prior consent except where required by law, or where we are concerned about your safety or the safety of others. You can withdraw or change your agreement for Richmond Borough Mind to hold or process your personal information at any time.

• I agree to monitoring information being held by Richmond Borough Mind and stored on their database
• I understand that the following information may be shared with my GP, my care team or emergency services if there is a concern over my wellbeing or safety; or risk to myself or others

The information that we keep is used to ensure that we can:

• contact you
• make informed decisions about services and support you need
• manage risks to your own wellbeing, and others’ wellbeing
• review services to ensure they are effective
• monitor numbers of people receiving a service
• show what the funding was used for

Protection Regulation 2018 (GDPR) and our Privacy Policy.