In order to process this referral, we need to record details of your client/patient. This will include ‘personal data’ (information which can be used to identify the client, such as their name, date of birth, contact details, etc.), and ‘special category data’ (information related to any of the following: racial or ethnic origin, political opinions, religious beliefs, trade union membership, health, sexuality or sex life, offences and/or convictions).
The client/patient does not have to consent to sharing their special category data, but it may limit the support we can offer if they choose not to. We will discuss our use of the information further with them when we first contact them.
The information will be stored on a shared electronic case management system accessed only by members of the Citizen Advice service. To comply with data protection legislation, we must ensure there is consent from the client/patient to record those details.
To submit this form, you must have gained prior consent from the client/patient to share with us the information you have provided below.
For more information about what we do with your information please read our Privacy Notice.
