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Consent to liaise form

Consent form - Penryn Welfare team - September 2022 to 31 August 2023

Please complete this form if you have either attended a meeting with the welfare team or have a meeting upcoming. Permission to share information enables us to link you in with appropriate support for your studies and to provide effective help with your wellbeing and welfare. Please complete all sections. Should you wish to amend or withdraw your consent at any point you can do so by emailing – this may impact the level of support we are able to offer.

More information

Part 1) FXplus
The Welfare team in Penryn are part of Wellbeing services for Exeter University and we respect your rights to privacy as outlined in the confidentiality statement (see link above). As we are based on the Penryn campus we work alongside Student Services which are provided by Fxplus. Information on their data sharing policies (see link above). Given the above, in order to provide an effective and safe service to you, we will share information from meetings and communications with you with members of staff from the Wellbeing and Living Support teams in FXplus. You may withdraw your consent to this at any point by contacting but please be aware that it may significantly limit the level of support that we are able to provide. To indicate whether or not consent is given to the above please complete the below information:

2) Consent within the University
At a meeting with you we will discuss the need to share information on a need to know basis with key University Colleagues/Departments. Examples could be confirming you have engaged with us for mitigation, liaising with the Student records team about registration for you, queries on your behalf with the Education Support team or letting staff know that you may want some extra support to catch up on missed sessions.

3) Consent to contact Parent/Emergency contact

4) External agencies/Individuals
It may be the case that you are engaged with an external service or agency and that it would be beneficial for liaison to take place between the Welfare team and them. Please indicate below if you are engaged with any of these services and wish for liaison to be permissible. If you are not engaged with a service please select ‘Not applicable’ from the drop down.

5) Exceptional Circumstances clause
Wherever possible staff will seek to obtain your agreement prior to liaison, however it is acknowledged that there may be some circumstances where this is not possible. There may be rare instances when Wellbeing Services are unable to maintain our commitment to confidentiality. In such circumstances we may need to contact relevant others such as your GP or other health professionals. Exceptions to confidentiality occur when Wellbeing Services believe you or others may be at risk of serious harm, when there are safeguarding concerns, and/or when a member of the team would be liable to civil or criminal court procedures if relevant information had not been disclosed. In certain exceptional circumstances (such as where there is an immediate and serious threat to your personal safety or to the safety of others), we may disclose information to your parents/emergency contact or engage with them if we consider this essential for your safety.

6) Submit form