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Community Companions referral form

To make a referral for yourself or someone else for support from Community Companions, please read the service member privacy notice then complete the online form. 

Service member privacy notice

Who we are 

We are Mind in Bradford, a local mental health charity, supporting people of all ages across Bradford District and Craven. We work in partnership with local authorities, the NHS and the voluntary and community sector.

To support you as best as we can, we process personal information about you and the people who help you, such as family, friends and professionals. We only do this to provide and improve our services, promote your wellbeing and keep everyone safe. We may use your information to:

  • Discuss how we can support you.
  • Assess your needs, plan, and provide you with support.
  • Monitor the effectiveness and fairness of our services.

Keeping your information safe

We store your information electronically in secure systems that can only be accessed by staff working across our services. In some services (and we will tell you if this is the case), we store your information on SystmOne; a digital NHS platform.

Sharing your information

We may share your information with trusted people involved in your life, such as health workers, social workers, youth workers, your parent/s or carer/s, the police or your school. Where possible, we will seek your permission before sharing, and we will not share against your wishes unless we are worried about your safety, or the safety of someone else.  

We may share your information in an anonymised form with our funders. We do not, and never will, sell your information for marketing purposes.

More information

If you would like to know more about how and why we process your information, the kinds of information we process, and what rights you have in relation to your personal information, please refer to the Privacy Policy on our website. Alternatively, you can request a copy in person or over the phone.

Phone: 01274 730815
Office: Kenburgh House, 28 Manor Row, Bradford, BD1 4QU
Email: [email protected]

Community Companions referral form

You must be:

• 18 years old or over

• Willing and able to give informed consent to this referral and to engage with befriending activity

• Be experiencing loneliness, social isolation, low mood, anxiety or depression and could benefit from face-to-face social interaction with a volunteer befriender in the community.

• Live in Bradford District (Bradford, Craven, Airedale and Wharfedale)

• Aware that this service is focused on building confidence in public places and social environments

Referrals for Community Companions must not:

• Lack mental capacity to consent to this referral

• Pose a risk to others, including staff and volunteers

• Have drug or alcohol abuse problems, or unsafe living environment

Personal information

Health and communication needs

Carer information

Diversity monitoring

• We use this information to help us improve fair access to our services for all, and to understand if there are any groups we could be better at supporting.

• The information is collected for research purposes and will not affect your involvement with Mind in Bradford in any way. Demographic information may be shared with funders, but it will not include personal details and cannot be linked back to an individual.

• Your data is handled in line with the Data Protection Act (2018). If you have any questions please contact us at [email protected] or 01274 730815

Next of Kin Details, please provide two

GP Practice

Essential referrer information

Please note that the one-to-one befriending support will be in place for three months, with an option of a further six months of group support, the information provided above is crucial in determining the support required.

Full details on how we use your data and keep it safe can be found in our Privacy Policy.

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Your privacy is important to us, we keep your information safe and we will never sell or swap your details for marketing purposes. You can easily unsubscribe from emails at any time using the link at the bottom of the email, or by contacting [email protected] Please see our privacy policy for more details.

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