Diabetes Enquiry Form

Complete our Diabetes Enquiry Form

Once submitted our GO Active, Get Healthy team will be in touch to explore how we can help you reach your goals.

Enquiry Form

Personal Information

Title:

First Name*:

Last Name*:

Age:

Telephone:

Mobile:

Postcode*:

Email*:

How did you find out about GO Active, Get Healthy?

Other:

For which districts would you like information?

The information you provide on this enquiry form will only be used to administer your interest in joining Go Active Get Healthy Diabetes (GAGH-D). The District Council and Active Oxfordshire are the joint data controllers of the information you provide, and are processing this data, contractually, in order to provide this service to you. GAGH-D will use your information in accordance with the UK GDPR and UK DPA 2018.

We will share your information with the District Council who is responsible for providing support and signposting to meet your physical activity needs as part of GAGH-D. Information that you enter on this form will be sent directly to the GAGH-D team to contact you and get started. Your data will be collected electronically or on paper and stored safely in a secure database.

* I give my consent for my personal information to be used as described in the above notice.

The GAGH-D team would like to contact you to provide advice and guidance to take part in physical activity, including regular follow ups to offer ongoing support.

Please be aware that you have the right at any time to withdraw this consent and to stop us from contacting you. If you would like to do so, please contact the GAGH-D district coordinator.

* I give my consent to be contacted by email, telephone or text message regarding GAGH-D.

The personal information you provide will be held for a period of 12 months following your last known contact with GAGH-D, after which it will be securely destroyed. You have the right to the access and removal of personal data concerning you.

What is 2+3? (just to prove you're not a robot)*: