Healthy Hub Enquiry Form Please complete our online to get in touch with the Healthy Hub team. Webform Red asterisk denotes a required answer. Contact Details Name First Name Last Name Address Address City/Town ZIP/Postal Code Your Email Telephone Number Please tick if you would be happy to receive support & advice from HHbEH via SMS or text message information As we have more people sign up to receive information about the services the HHbEH can offer, we would like to understand how to match these to the health and wellbeing needs of the community we are supporting. Please indicate from the list which particular source(s) of information would be of most benefit to you. Help to stop smoking Nutrition and healthy eating advice Mental health and wellbeing Stress and anxiety Physical activity Support Groups for Long term conditions e.g. lung conditions, epilepsy, dementia Loneliness and isolation (social groups and activities to join) Carers support Adults or Children with learning disabilities Recovery addiction support Female or Male Domestic Abuse support NHS Health checks Sexual health advice Cancel out Cancer campaign information on other partnersinformation If you have previously received support from any of our partner services it would help us to know this. Future Living Broxbourne and East Herts CVS East Herts Citizens Advice Service Mind in Mind Hertford Herts Mind Network Mudlarks Community Garden Other If other, please specify How did you hear about us? How did you hear about us? - None -East Herts websiteGP surgeryNHS link worker/community navigatorSocial mediaWord of mouthNewspaperGoogleEmail from usEmail from another organisationOther… Other Gender - Select -MaleFemaleAgenderGender fluidTransgenderOtherUndisclosed Age - Select -18-2425-3435-4445-5455-6465-7475-8485+Undisclosed Ethnicity - Select -Asian - BangladeshiAsian - ChineseAsian - IndianAsian - PakistaniAsian - otherBlack - AfricanBlack - CaribbeanBlack - otherMixed - White/AsianMixed - White/Black AfricanMixed - White/Black CaribbeanMixed - otherWhite - BritishWhite - IrishWhite - Gypsy/TravellerWhite - otherArabAny other Disability - Select -DisabledNot disabledUndisclosed On submission of this form you will receive an email reply confirming your selection of choices and the details you have provided. This electronic record is equivalent to a signed record expressing that you are in agreement with the information you have supplied and understand this. Declaration For the purposes of current data protection laws the information you supply the Council as part of your application will be used for the purposes of dealing with your request and retained as per our published corporate data protection privacy policy which can be found on the East Herts District Council Data Protection page (this link opens in a new window). From time to time this information may be shared with other Council departments and / or outside partners to process your request as effectively as possible. Please confirm you have read the above privacy notice In addition the Healthy Hub East Herts (HHbEH) will collect your personal data in order to effectively deliver, monitor, evaluate and review the processes which support the HHbEH. These would typically include HHbEH group and client 1-2-1 meetings to identify appropriate support, signposting and/or referral to HHbEH provider organisations and involve follow up communication and feedback as required I agree Submit Leave this field blank Community & Wellbeing menu Village & Community Halls owned by East Herts Anti Social Behaviour Assets of Community Value Overview Community Events Community Events & Facilities Community Triggers Funding for Community Organisations and Individuals Healthy Hub East Herts Other Village Halls & Community Centres in East Herts Report Vandalism & Graffiti Safeguarding Children & Vulnerable Adults