Self-referral form

Welcome to Worcestershire Association of Carers. We will be in touch as soon as possible.
Please tick the box below that you feel applies to you:

The new General Data Protection Regulation (GDPR) in the European Union (EU) gives individuals more control over how their personal information is processed. Worcestershire Association of Carers adheres to these regulations and takes your privacy seriously.

We will only collect personal information about you which is essential to enable us to support you. We will keep your personal information private and secure. We will not share your personal information with anyone else without your agreement, unless we are legally obliged to do so. When reporting to our funders only anonymous information is shared.

You have the right to ask that your personal information be kept up to date, the right to access your personal information, and the right to ask to be forgotten on our records. If you require any further details, please let us know.

This is a self referral form to make Worcestershire Association of Carers aware of the needs and support you may have in your caring role. Under the Care Act 2014 you are entitled to access Information, Advice and Guidance to enable you to continue caring.

By completing this form I agree that Worcestershire Association of Carers may hold confidential information about me and can exchange this on a ‘need to know’ basis, with other agencies that may assist me, including, but not limited to: Voluntary Organisations, Health and Social Care Professionals.