East Birmingham Social Prescribing Referral Form

Social prescribing is an approach that connects people to activities, groups, and services in their community to meet the practical, social and emotional needs that affect their health and wellbeing.

Dear user, please ensure you select the GP practice that you are registered with otherwise the referral will be delayed in being allocated to the relevant Social Prescribing Link Worker. Once you have completed the form, you will be contacted in due course. For any queries, please email [email protected].

NB: Without selecting a GP Practice, this referral will not be allocated to a social prescribing link worker.
Selected Value: 1
1: Not Able, 2: A little Able, 3: Quite Able, 4: Very Able
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
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, Our Health Partnership, Bordesley East PCN (Only whichever is relevant to you). 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.