As part of its work, Streetwise part of Everyturn Mental Health, needs to collect and store sensitive personal information about you. In order to do so, the law on data protection requires Everyturn Mental Health, to receive your explicit consent.
Explicit Consent:
I hereby consent to Everyturn Mental Health, collecting and storing sensitive personal information about me/my dependant concerning the support, advice and / or counselling that I/ my dependent receives when I/ my dependent accesses Streetwise’s services. The sensitive personal information that Everyturn Mental Health, will collect and store will include; name, date of birth, address, residential, marital, ethnicity, medical details concerning my mental and physical health, and emotional wellbeing.
I understand that any sensitive personal information collected and stored by Everyturn Mental Health, will:
• Be retained for a minimum of eight (8) years after support / counselling has ceased
• Be processed in accordance with the 2023 Privacy Notice, which I have read and understood.
By signing this consent form, I confirm and understand that:
• Confidentiality has been explained to me and I agree that my/ my dependant’s sensitive personal information can be shared with others where another person or my dependant is at risk of significant harm
• Sensitive personal information about me/ my dependant can be collected and stored securely by Everyturn Mental Health, and I understand that such information can be seen by other workers within Everyturn Mental Health.
• With my prior explicit consent, my dependant’s sensitive personal information can be shared with others outside of Everyturn Mental Health
• I will contact Streetwise, part of Everyturn Mental Health, if I/ my dependant cannot make an appointment that has been made for them
• If referred by someone else, Streetwise, part of Everyturn Mental Health, may inform the referrer when counselling and / or support comes to an end
• My/ my dependants’ rights at Everyturn Mental Health, include how to make a complaint and what rights I/ they have in relation to their sensitive personal information, have been explained to me.
• I may request to withdraw my consent to Everyturn Mental Health, collecting and processing my dependant’s sensitive personal data at any time
I have read and understood the above and give my explicit consent to Everyturn Mental Health, collecting and storing mine and/or my (dependants) sensitive personal information in accordance with the 2023 Privacy Notice:
