Social Prescribing Webform Bournville & Northfield PCN

The Active Wellbeing Society delivers a wide range of free activities and support services for adults in partnership with your GP practice. Please complete the form below and select the areas you are interested in. Once the form is received, your Social Prescribing Link Worker will send you the related information and further details.

PLEASE ENSURE THE SECTIONS WITH AN ASTERISK (*) ARE COMPLETED, OTHERWISE THE FORM WILL NOT SUBMIT - THANK YOU

For patients of the following GP Practices only: College Green Medical Practice, St. Heliers Medical Practice or Wychall Lane Surgery
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Selected Value: 1
1 - Not able, 2 - A little able, 3 - Quite able, 4 - Very able
Selected Value: 0
Use the slider to select on a scale 0-10
Selected Value: 0
Use the slider to select on a scale 0-10
Selected Value: 0
Use the slider to select on a scale 0-10
Selected Value: 0
On a scale where 0 is “not at all anxious” and 10 is “completely anxious”,
ALL these activities will take place online and you will need access to internet (Except Sense which requires telephone access only)
The Wellbeing Card is required to enable you to access the free activities through The Active Wellbeing Society. You will be issued with a membership card known as Wellbeing Card which you will receive in the post. Want to get active outdoors? Why not take part in our outdoor activities in Parks, Streets and open green spaces? There are free outdoor activities in over 80 parks and green spaces throughout the year. So join us and try something different from walking, running and cycling to Zumba and tai chi. If you live or work in Birmingham, you can get active for free and there’s something for everyone. The Wellbeing Card can be used to access all of The Active Wellbeing Society’s free services- including activities on Zoom, borrowing items at Share Shacks and much more. To sign yourself up for a card please visit: https://www.kineticinsightpro.com/birmingham/ To find out more info visit: https://theaws.co.uk/join-us/wellbeing-card/
Privacy Notice How information about you will be used Information you provide is collected and stored securely by The Active Wellbeing Society Limited (community benefit society registered with the ICO; Reg. No. ZA266982), who provide services on behalf of Birmingham City Council, Sport England or Our Health Partnership. We collect this information to enable us to administer the membership we hold with you, to provide better services, to promote public health and physical activity and monitor the effectiveness of our programmes, to maintain our accounts and records, to prevent fraud and misuse of public funds and to report to our funders. We will keep this information during the time of your involvement with our services and for a period of 3 years afterwards. We may share anonymous information about you with our partner organisations and funders, in order to provide you with appropriate services, to monitor outcomes related to physical activity and healthy lifestyles and to facilitate research and insight. We and our partners will hold this information in confidence and comply with all our responsibilities under the General Data Protection Regulation and Data Protection Act. By signing up, you agree to these terms. You have a right to withdraw your consent at any time at any time by contacting us on 0121 728 7030 or emailing [email protected]. If you would like a copy of our Data Protection Policy please visit http://www.theaws.org/privacy-notice Alternatively, you can find out more about your rights or complain to the Information Commissioner’s Office at ico.org.uk.