Voices in Exile Consent Form

Client confidentiality & consent

Name

Address

Post Code

Date of Birth

Part A: storing and processing data

I agree *

Date

Part B: obtaining and disclosing data

NHS trusts, doctor, health practitionersHome OfficeGovernment agencies (e.g. Department for Work and Pensions, Job Centre)HMRCLocal authorities and social servicesAccommodation providers and housing trustsVoluntary sector organisations/charities/refugesSolicitors/immigration advisers/barristersSchool and education providersPolice/ACRO criminal records officeLocal Member of ParliamentOther

Data disclosure *

I understand that ViE will only obtain and disclose my data if it is in my best interests and will keep me informed of disclosures that are made on my behalf. I understand that I can withdraw this consent at any time by notifying ViE.

Date