Social Work Consent template

1. Nature of Support

• Social work support may include assessment, advocacy, signposting to services, safety planning, and coordination with other agencies, tailored to my individual circumstances and goals.

2. Information Sharing with Other Agencies

• I understand my social worker may need to share relevant information with other agencies (e.g. health, housing, education) to coordinate support, and will seek my consent to do so wherever possible.

3. Confidentiality and Safeguarding

• Information is kept confidential except where there are safeguarding concerns about a child or adult at risk, or where disclosure is required by law, in line with statutory safeguarding duties.

4. Data Protection

• My information is processed under the UK GDPR and Data Protection Act 2018, and I may request access to my records at any time.

5. Right to Withdraw

• I understand I may withdraw consent to voluntary support at any time, except where intervention is required by statutory duty or court order.

Client Information

• Full NameText
• Date of BirthDate
• AddressText
• Phone / EmailText

Social Worker Information

• Social Worker NameText
• Social Work England Registration No.Text

Emergency Contact

• Contact NameText
• Relationship / PhoneText

Acknowledgment and Signature

• Client SignatureSignature
• Date signed (client)Date
• Social Worker SignatureSignature
• Date signed (social worker)Date

• By signing below, I confirm I have read and understood this consent form and voluntarily agree to social work support.