Melanoma-Me Referrals

At Melanoma-Me Foundation, our priority is to make sure that everyone affected by melanoma feels supported, heard and able to access the care they need, regardless of their circumstances.

We are committed to keeping our counselling service free wherever possible, because we believe that financial circumstances should never be a barrier to receiving emotional support.

As we do not receive regular funding for this service and rely heavily on the generosity of our community, we would be incredibly grateful to anyone who is able to make a contribution of £15 or more per counselling session.

We completely understand that not everyone will be in a position to contribute, and there is absolutely no obligation to do so. Your circumstances will never affect your access to our support.

If you are able to contribute, even a small donation can make a real difference. It helps us continue to provide compassionate, specialist support to people living with melanoma and their loved ones, when they need it most.

Referral form

First Name

Last Name

Date of Birth

Gender

Phone

Address

Information

How did you hear about us?

Services required

I agree for Melanoma-Me Foundation to file my details for referral and contact only and stored appropriately in a locked cabinet. My details may not be passed onto third parties without my consent. My data will be held for 7 years, thereafter, will be appropriately disposed of. I understand that Melanoma-Me Foundation require my details for contact and referral purposes and therefore, I give permission to be contacted by email, text, phone or post.

I have read and agree to the GDPR guidelines (see below)

*The new guidelines for GDPR come into force 25th May 2018. MelanomaMe holds data classified as “personal data” and “sensitive personal data” This information is held both manually and on computer. Where the company holds files or information on an individual, they are held on them to comply with the project requirements. They can view manual files by putting requests in writing giving a 24 hour notice. No information will be used for direct promotion or sold or passed to third parties unless agreed with the service user and in case of young people their parent’s consent. All information is stored securely in locked cabinets. All data held on computer is only accessible by authorised staff members via a password. Counselling information will be held under a coded correspondence that can’t be linked to a service users name or contact details. Personal information will be deleted from messages or emails and stored as above. Service user’s data will only be collected for the purpose of referral information and held for a maximum of 7 years after no longer accessing MelanomaMe’s services. All service users are given the option to opt out of email, telephone or text messages. Service users have the right to ask for their information to be taken of MelaonmaMe’s accessible data. However, counselling information will be kept securely filed as above and only accessed if the service user gives written permission, to which this will then be correctly destroyed after 7 years of the service users no longer accessing MelanomaMe’s services.