The information submitted using this form will be held and used in accordance with the Data Protection Act 1998. The Data Controller is Midlands Partnership NHS Foundation Trust. The Trust will not disclose such information to any unauthorised person or body but, where appropriate, will use such information in responding to your complaint. The Trust will store this data in an electronic format and may also use this data in connection with the prevention or detection of fraud or other crime.

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Service User's Date of Birth (If known)

Privacy Policy

By submitting this form, all details will be reviewed and stored in accordance with the Privacy Policy and held by the Customer Services Team. You do not have to fill in all fields of the form but by completing them this will help us to respond to you in a timelier manner.  When entering your details as a referrer to the service they will be held by the Midlands Partnership University NHS Trust (MPFT) only unless there is a legal duty to share your data under the Data Protection Act 2018.


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