MS / Citizens Advice Teignbridge Enquiry Form

This form is for anyone with MS or anyone affected by it (e.g. a family member, a carer or someone who works with someone with MS) who needs generalist advice or information, whether this is about benefits like Personal Independence Payment, housing or anything else. Our specialist MS Advocacy Project caseworker will contact you as soon as possible, usually within a week or so.

If you cannot wait this long, please contact us via our general freephone advice service: 0808 278 7997. Our website also has a number of other ways to contact us.

I am completing this form for:*

Myself or a member of my familyA client of the agency I work for

Agency Name

Staff member name

Staff email

Client Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal / Zip CodeCountry

Preferred telephone number for us to contact you on*

Can we leave a message if you are not in*

YesNo

E-mail

Details of your enquiry or problem

Privacy Policy

As a local Citizens Advice office, we collect and use personal information as specified by Citizens Advice private policy.

We are registered with the Information Commissioner’s Office under Z4604455 and will process any personal data in accordance with the General Data Protection Regulation and Data Protection Act 2018.

When we record and use personal information we:

only access it when we have a good reason
only share what is necessary and relevant
don't sell it to commercial organisations

We need to record client information to help with their enquiries. We have a legitimate interest to do this.

I consent to you recording and using my personal data*

YesNo

We need your consent to record and use your special category personal data

We need your explicit consent to use some information, including your ethnicity, religion, health conditions and sexual orientation.

If you agree, we'll use this information, which is known as 'special category personal data', to:

give you advice
help us gather data to improve our services
support our research in a way that you can't be identified

We'll make sure all your information is kept safe in our secure case management system.

I consent to your holding information on my (please tick all of those you agree to):

Health conditions (you must select this option)EthnicityReligionSexual orientation

We are registered with the Information Commissioner's Office under Z4604455 and will process your personal data in accordance with the General Data Protection Regulation and Data Protection Act 2018. Please refer to our online Privacy notice at https://citizensadviceteignbridge.org.uk/privacy-policy/ for more information on how your personal data will be processed and stored.