W&R Bartley Green MP – Over 65s Please enable JavaScript in your browser to complete this form.The ASH team offer single adults and households without children support to maintain accommodation, resolve housing difficulties, budget, manage money and access welfare benefits in partnership with a range of local organizations. They can also offer support improve your wellbeing and access community activities. If you are an adult or couple aged 65 or over and you do not have children in your household, you can request to meet ASH team at Bartley Green Medical Practice by filling in the form below, and we will contact you as soon as possible: Name *FirstLastDate of birth: *Address including postcode: *Your contact telephone / mobile number: *Please indicate if you would prefer a face-to-face meeting or telephone call with the Adult Support Hub: Face-to-faceTelephoneGDPR Agreement *Tick to confirm : I consent to be contacted via telephone or SMS by the social prescribing service to arrange a meeting with the ASH team GDPR Agreement *Tick to confirm: I give consent for my social prescribing link worker to update my shared care record at my GP surgery with any conversations or referrals related to my personalised care and support planGDPR Agreement *Tick to confirm: I agree to the data protection policy of The Active Wellbeing Society. How information about you will be used: Information you provide is collected and stored securely by The Active Wellbeing Society Limited, a charitable community benefit society (No. 7595) working in partnership with Our Health Partnership (OHP) and Weoley & Rubery PCN. 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 2018. For details about TAWS' Privacy Policies please visit www.theaws.co.uk/privacy-policySubmit