Donor dashboard - Cornwall Mind

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- Step 1 of 2

Please complete and submit this referral form.

We aim to make contact within 2 - 3 weeks of receiving your form. Thank you.

Difficulties accessing this form?

If you have any difficulties accessing this form, please call 01208 892855 and leave a message with your name and contact details and we will call you back.

Last Name: *

First Name: *

Date of Birth: *

Address: *

County: *

Email: *

Postcode: *

Phone: *

Reason for referral: *

If you know which service you would like, please tick box(es) below *

5 Ways to Wellbeing Programme – Various locations
Allotment Group - Bodmin
Art for Wellbeing - Newquay
Singing in Mind - Looe
Supportive Minds - St Austell
Supportive Minds - Newquay
Supportive Minds - Liskeard
Supportive Minds - Looe
Singing for Wellbeing (For those bereaved by suicide) – Camborne
Sing For Joy (Open to all) - Camborne
Walking Group - Bodmin
Hope Walks (For those bereaved by suicide) – Various Locations
Ember - Binge Eating Disorder Service in North & East Cornwall
Hearing Voices Group (For those experiencing voices) – Bodmin
Hearing Voices Group (For those experiencing voices) - Penzance
Radio and Podcasting - Falmouth
Radio and Podcasting - Truro
Music in Mind - Bodmin
Creative Writing Workshop
One to one peer support service
I'm not sure, please call me to discuss

Data protection permission *

Yes

In view of the way we process and store your data in compliance with General Data Protection Regulation (GDPR), it is essential we have your permission. We take your privacy seriously and promise to never sell your data. You can find out more about your rights, how we keep your personal information and how we keep your details safe and secure by reading our Privacy Policy, which can be accessed through our website or by contacting the office. For more information, or to withdraw your consent to us processing your data, contact the office on 01208 892855 or email: [email protected]

If you are a professional making this referral please add your contact details below.

Name:

Email

Organisation:

Phone Number:

Equality and Diversity Monitoring (Optional)

We want to know a bit more about you, to understand who we are engaging with our work, and who we need to work harder to reach. We also want to make sure we understand the needs of all the communities we work with. Completing these questions is voluntary, and the information you provide will be entirely anonymous. Thanks for your help.

What is your gender? *

Female
Male
Non-binary
Another/prefer to self-describe
Prefer not to say

Please specify:

Have you ever identified as trans? *

Yes
No

What is your sexual orientation? *

Gay/Lesbian
Heterosexual/Straight
Another/Prefer to self-describe
Prefer to not say

Please specify:

What is your ethnic background? *

White
Asian
Black
Mixed Heritage
Another/Prefer to self-describe
Prefer not to say

Please Specify

Do you consider yourself to have a long term health condition or learning difference that has a substantial or long term impact on your ability to carry out day to day activities? *

Yes
No
Prefer not to say

Which of these categories best represents your experience of mental health problems? (Please tick all that apply) *

I have personal experience of mental health problems
I use/have used mental health services
I am a family member of somebody who has experienced mental health problems
I am a friend to someone who has experienced mental health problems
I care for or look after someone who has mental health problems
Another (please specify if you wish)
None of the above

Please specify:

Where did you hear about Cornwall Mind? *

I have been with you before
A healthcare worker told me about you
Another charity told me about you
A friend or family member told me about you
Facebook
Instagram
Through an internet search
Through national mind
At an event
Other
Prefer not to say

Please specify:

Search our site

Home
About Us
What We Do
Get Involved
- Work with us
- Volunteer with us
Support Us
News
Contact Us

Make a donation Fundraise Urgent Help

Please enable JavaScript in your browser to complete this form.

- Step 1 of 2

Please complete and submit this referral form.

We aim to make contact within 2 - 3 weeks of receiving your form. Thank you.

Difficulties accessing this form?

If you have any difficulties accessing this form, please call 01208 892855 and leave a message with your name and contact details and we will call you back.

Last Name: *

First Name: *

Date of Birth: *

Address: *

County: *

Email: *

Postcode: *

Phone: *

Reason for referral: *

If you know which service you would like, please tick box(es) below *

5 Ways to Wellbeing Programme – Various locations
Allotment Group - Bodmin
Art for Wellbeing - Newquay
Singing in Mind - Looe
Supportive Minds - St Austell
Supportive Minds - Newquay
Supportive Minds - Liskeard
Supportive Minds - Looe
Singing for Wellbeing (For those bereaved by suicide) – Camborne
Sing For Joy (Open to all) - Camborne
Walking Group - Bodmin
Hope Walks (For those bereaved by suicide) – Various Locations
Ember - Binge Eating Disorder Service in North & East Cornwall
Hearing Voices Group (For those experiencing voices) – Bodmin
Hearing Voices Group (For those experiencing voices) - Penzance
Radio and Podcasting - Falmouth
Radio and Podcasting - Truro
Music in Mind - Bodmin
Creative Writing Workshop
One to one peer support service
I'm not sure, please call me to discuss

Data protection permission *

Yes

In view of the way we process and store your data in compliance with General Data Protection Regulation (GDPR), it is essential we have your permission. We take your privacy seriously and promise to never sell your data. You can find out more about your rights, how we keep your personal information and how we keep your details safe and secure by reading our Privacy Policy, which can be accessed through our website or by contacting the office. For more information, or to withdraw your consent to us processing your data, contact the office on 01208 892855 or email: [email protected]

If you are a professional making this referral please add your contact details below.

Name:

Email

Organisation:

Phone Number:

Equality and Diversity Monitoring (Optional)

We want to know a bit more about you, to understand who we are engaging with our work, and who we need to work harder to reach. We also want to make sure we understand the needs of all the communities we work with. Completing these questions is voluntary, and the information you provide will be entirely anonymous. Thanks for your help.

What is your gender? *

Female
Male
Non-binary
Another/prefer to self-describe
Prefer not to say

Please specify:

Have you ever identified as trans? *

Yes
No

What is your sexual orientation? *

Gay/Lesbian
Heterosexual/Straight
Another/Prefer to self-describe
Prefer to not say

Please specify:

What is your ethnic background? *

White
Asian
Black
Mixed Heritage
Another/Prefer to self-describe
Prefer not to say

Please Specify

Do you consider yourself to have a long term health condition or learning difference that has a substantial or long term impact on your ability to carry out day to day activities? *

Yes
No
Prefer not to say

Which of these categories best represents your experience of mental health problems? (Please tick all that apply) *

I have personal experience of mental health problems
I use/have used mental health services
I am a family member of somebody who has experienced mental health problems
I am a friend to someone who has experienced mental health problems
I care for or look after someone who has mental health problems
Another (please specify if you wish)
None of the above

Please specify:

Where did you hear about Cornwall Mind? *

I have been with you before
A healthcare worker told me about you
Another charity told me about you
A friend or family member told me about you
Facebook
Instagram
Through an internet search
Through national mind
At an event
Other
Prefer not to say

Please specify:

Search our site

Home
About Us
What We Do
Get Involved
- Work with us
- Volunteer with us
Support Us
News
Contact Us

Cornwall Mind

Cornwall Mind
2A Hamley Court
Dennison Road
Bodmin
PL31 2LL

01208 892 855
[email protected]

Charity Number: 1176942

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Instagram
YouTube
LinkedIn
Spotify
Apple Podcast

Cookie Policy

Policies and Procedures
Accessibility Statement
Terms and Conditions
Cookie Policy

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Cornwall Mind

Cornwall Mind
2A Hamley Court
Dennison Road
Bodmin
PL31 2LL

01208 892 855
[email protected]

Legal

Policies and Procedures
Accessibility Statement
Terms and Conditions
Cookie Policy

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Facebook
Instagram
YouTube
LinkedIn
Spotify
Apple Podcast

© 2025 Cornwall Mind
Registered in England
Charity No. 1176942

Policies and Procedures
Accessibility Statement
Terms and Conditions
Cookie Policy

Mind Theme © 2025 C27 Media Ltd