Referral

I am looking for help for myself
I am a health or social care professional
I am looking for help for a friend or family member

Your Details

How we use your information

Leeds Mind is committed to protecting and respecting your privacy and keeping your data secure. By providing us with your data you are giving us your consent to process your data. We will only process your personal data to provide you with the service that you have requested from us and provide (anonymous) feedback to our commissioners and funders. To read our full privacy statement, please follow our privacy statement tab on this website.

Referral information

Please confirm that your client is aware of and has consented to this referral.

Client's Details

Referral information

Are there any risks we should be aware of when working with the client?

Your Details

Please confirm that your friend/family member is aware of and has consented to this referral.

Your friend/family member's details

Your Details