Your NHS – Working together to shape Dorset’s health

Thank you once again for completing the survey - your views matter.
The next stage of improving local psychiatric liaison services in Dorset is for us to use local views to inform our plans.
We are setting up a reference group to help with this. 
This group of local people and providers will meet about 3 times in the next few months.
If you would like to be involved please provide us with your details below.
These will be stored in accordance with current Data Protection regulations.
Who will have access to your information?
Your information will be held securely and will only be accessed by NHS Dorset Clinical Commissioning Group (CCG) Engagement and Communications team and authorised staff involved in this project.
Everyone at the CCG has a responsibility, under Data Protection Law, to protect your personal information.  We will ensure that it is stored, used and transferred in accordance with the Act and all other applicable legislation.
Retention of information and unsubscribing
We will hold your details in accordance with the Records Management Code of Practice for Health and Social Care 2016, and the CCG's Records Retention Policy.
You can unsubscribe from being involved in this reference group at any time by e-mailing us at or by telephoning 01202 541946.
Once you have unsubscribed you will stop recieving information about the reference group.  We will delete your details.
Data Protection Act - your consent.
I agree to allow my personal information to be stored by NHS Dorset Clinical Commissioning Group (CCG), so that I may take part in this reference group.  I understand that Dorset CCG is committed to protecting my privacy and will use my information lawfully, in accordance with the Data Protection legislation, for the purpose set out in this form.
My information will be held securely, will not be shared with other organisations without my consent an

* 1. Please tick to provide your consent for us to store you information as outlined above and to give NHS Dorset CCG permission to contact you about the Psychiatric Liaison Reference Group.

* 2. Your name:

* 3. Your email address:

* 4. Your telephone number:

* 5. Are you:

Thank you so much - your interest and support are really important to us.