Staying Well Service Referral Form

Your staying well service is committed to providing the highest standards in all our interactions with you. We aim to offer you a first class service and hold dignity and privacy of all our employees accessing our service at the heart of all we do.

Your staying well service is confidential and we protect any information about your individual circumstances that you choose to share with us.

We keep computer based records of all the information you provide. This enables us to offer you a professional service and to ensure you receive appropriate advice and support. All personal and sensitive data is processed according to the requirements of the General Data Protection Regulation (GDPR) 2018.

In rare instances, if a member of the Staying Well Service has good reason to believe that you or others may be at risk of serious harm, we may share information with other relevant parties. In such circumstances, we would aim to discuss this with you first.

In the case of physiotherapy referrals, we may share assessment reports with your Line Manager and HRBP because the recommendations made will enable continued support, and ensure your welfare on returning to work after your injury or illness.

Your Staying Well Service may collect routine statistical information, which is later anonymised for audit and evaluation purposes. 

Should you wish to explore further any queries arising from this statement please contact us and we will be happy to discuss. 

Please note that once you finish filling in the referral form and click submit, it should say "Thank you for your submission. Your details have been sent to the Staying Well Service. A member of the team will contact you within one working day."