Practitioner / Other Referral Form

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Equality and Diversity Data

We would like you to complete this form in order to help us understand who we are reaching and to better serve everyone in our community. The information will be used to provide an overall profile analysis of our client base. If you would like the form in an alternative format or would like help in completing the form, please contact a member of staff. All information will be kept in line with GDPR regulations and you are under no obligation to complete this part of the Referral Form.

GDPR Statement

Oakleaf Enterprise are the Data Controller of the information you have provided. Due to the nature of our work with you, we are required to collect personal data about you which will include special categories of personal information. This information will only be collected from you and used by us to assist you, it will not be shared with third parties unless the law allows. We have a data protection regime in place to oversee the effective and secure processing of your data, we will hold your information for 6 years unless you instruct us to delete it once the relationship has ended. We would like to be able to send you information and /or reminders about activities and appointments by post, telephone email and/or SMS. If you agree to being contacted in this way please sign below.

Your referral is almost complete...

To submit your form, please press the 'send' button below. Your referral will be sent to our Client Services team who will contact you within 7 working days from our office number 01483 303649. For immediate support contact Mental Health Crisis Helpline: 0800 915 4644. The Guildford Safe Haven which is based at our Oakleaf premises and provides out-of-hours support for people and their carers who are experiencing a mental health crisis or emotional distress, is open 6pm-11pm, 365 days a year. This is an evening and weekend drop-in service, so no appointment is needed. Everyone is welcome. Address: Oakleaf Enterprise, 101 Walnut Tree Close, Guildford, GU1 4UQ