• Wellsprings - Music Group Application

    Herefordshire Mind in partnership with Encore run a weekly music and songwriting group at Herefordshire Mind. This runs weekly on a Friday between 12:30pm and 2:30pm at Hub for Hope. Please fill out the below application form to show interest for the group and a member of the team will get back to you with the availability for when you can attend.
  • What other services are you currently receiving support from for your mental health?*
  • Where did you hear about the music/songwriting group?*
  • Thank you for expressing your interest!

    A member of the team will get back to you shortly with more information.
  • Wellsprings Referral

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    Herefordshire Mind has made recent changes to our data policy please review our new Data consent statement and sign/click to agree to our terms and conditions.

     


    Why we need your information

    To support you, Herefordshire Mind needs to collect and keep some information about you. This may include your name, contact details, and information about your health, wellbeing, and support needs.

    We look after your information carefully and follow UK data protection laws.

    What you are agreeing to

    By signing this form, you agree that Herefordshire Mind can:

    Keep and use information from referral forms and requests for support.
    Keep notes and records about the support you receive.
    Contact you while you are using our services.
    Share information within Herefordshire Mind so that you do not have to repeat your story to different staff members.
    Share information with organisations such as emergency services, safeguarding teams, or other appropriate agencies if we are worried about your safety, someone else's safety, or if the law requires us to do so.
    How long we keep your information

    We will keep your information securely and only for as long as we need to, following GDPR and our data protection and record-keeping policies.

    Your choices

    If there is anything you do not understand, please ask a member of staff before signing.

    You can change your mind and withdraw your consent at any time by contacting us:

    Email: info@herefordshire-mind.org.uk
    Phone: 01432 271643
    Address: Heffernan House, 130-132 Widemarsh Street, Hereford, HR4 9HN

    Consent

    I have read and understood this information and agree to Herefordshire Mind using my information as explained above.

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