Client ReferralClient Referral Privacy Notice / ConsentCitizens Advice Doncaster Borough collects and holds your personal information. We use this information to:Make decisions about your support and advice needsHelp us to work with you and agree the support and advice you needWork effectively with others who may also provide you with support and adviceMake sure we manage our services effectivelyThis includes personal characteristics and sensitive information (special category data) relevant for the services we provide. The information we collect may be stored electronically, on paper or a mixture of both. We will not disclose any information provided ‘in confidence’ to anyone else without permission, except in the few situations where disclosure is required by law, or where we have good reason to believe that failing to share the information would put someone at risk.We need to obtain your consent to store your information and before doing so please read our privacy statement.Do you give consent? * Yes NoYour Personal Details Title * Name * First Surname * Surname Date of Birth * NI Number Email Address * Telephone * Address * Post Code * How would you like to be contacted to discuss your issue? * Phone Email Text VideoAlternative Contact Name Telephone Relationship to you Address Post Code Service needsPlease tick all that apply to help us identify the best service(s) to meet your needs * Benefit/Income Issue Housing/homelessness Carer Debt/money worries Long Term Health Condition OtherOther Please let us know why you would like a referral appointment: * MonitoringFor monitoring purposes please complete all sections. Tick only one box in each section.Gender * Male Female Do not wish to discloseEthnicity * White British White Irish White & Black Caribbean White & Black African White & Asian Indian Pakistani Bangladeshi Black Caribbean Black African Chinese Arabic Do not wish to disclose OtherOtherDo you consider yourself to have a disability? * No Yes Do not wish to disclose reCAPTCHA If you are human, leave this field blank. Submit
