Healthwatch Hounslow are coordinating and facilitating a Safeguarding user forum to ensure feedback can align with and feed into the Quality Assurance reporting schedule. Give your permission to take part in the Hounslow Safeguarding Adults Forum. Please make sure you have read the
information before completing this Consent Form
If you would like to join us to talk about your safeguarding experiences, we need your permission. If you are happy to take part, please tick the Yes box. If you have any questions or would like to know more, please contact viviane@healthwatchhounslow.co.uk.
1. I have read and understood the information about this project provided on https://www.healthwatchhounslow.co.uk/safeguarding-adults-forum.
2. I know that I do not have to take part.
3. I know I can refuse to answer questions if I want or leave at any time. If I decide to do that, then any information I have already given will not be used or shared and will be destroyed straight away.
4. I agree that my information can be used in the report given to Hounslow Council – but it won’t say my name.
5. I understand that any personal information that can identify me will not be shared beyond the project team.
6. If I say something that is putting myself or someone else in danger, I understand this may have to be reported.
7. I agree to take part in this project and to be contacted by Healthwatch Hounslow.
10. Your telephone number
11. Your email address (if you have one)
13. Allocated Social worker details (optional):