Confidential Intake

Let's understand how we can help.

This form takes about 5 minutes. Everything you share is confidential and only used to match you with the right support. There's no pressure to answer everything — share what feels right.

Fields marked with a red border below are required. Your responses go directly to a consultant — no one else sees this information.

    1. Personal Details




    2. Reason for Reaching Out




    3. Current Situation





    3.5 Quick Clinical Indicators - tick any that apply


    4. Immediate Needs



    5. Safety and Boundaries




    6. Support Preferences




    7. Communication Workflow



    Consent for digital support (email/chat follow-up)

    8. Service Pathways


    9. Explicit Consent for Sensitive and Mental-Health Data

    Why We Ask for Your Consent

    Humura collects certain types of information that are considered sensitive under Uganda's Data Protection and Privacy Act, 2019. This includes details about your mental health, emotional wellbeing, personal experiences, and any challenges you may be facing. We request your explicit consent so we can use this information responsibly and transparently.

    Purpose of Collecting This Information

    Your information enables us to:

    • Understand your wellbeing and current situation

    • Provide consultations, care pathways, and personalised support

    • Offer digital tools and resources tailored to your needs

    • Ensure your safety and appropriate follow-up

    • Improve the quality and effectiveness of our services

    How Your Information Is Used and Protected

    Your data will be:

    • Accessed only by authorised Humura consultants and support staff

    • Stored securely using encrypted systems and strict access controls

    • Retained only for the period necessary to deliver support and meet legal obligations

    • Never shared without your permission unless required for safety or legal compliance

    Your Rights

    You have the right to:

    • Access your personal information

    • Request corrections

    • Request deletion

    • Withdraw your consent at any time

    • Ask how your data is used, stored, or shared

    To exercise these rights, you may contact our Data Protection Officer.

    What happens next?

    A consultant reviews your intake within 24–48 hours and follows up using your preferred contact method. If you selected "urgent," we'll prioritise your response.