GoodSAM

NHS Volunteer Responders referral and Steward Volunteer request form

This form is for:

Requesting Steward Volunteers for COVID-19 vaccination sites
Referring individuals or NHS organisations for support from volunteers. The types of support are listed below.

When you submit your first request you will receive an emailed verification link. Once you have clicked this link you will automatically be registered and your requests for support will be live in the GoodSAM app. This means the app will allocate the tasks to available volunteers in relevant locations. All of your further referrals will be live immediately. You will have access to a dashboard which shows whether the requests/referrals you have entered have been matched with volunteers.

Full instructions are in this PDF instruction document.

Other ways to request volunteers are:

By phone on 0808 196 3382.

Please note that we will process personal data in accordance with our Privacy Notice - Referral Parties, which you can find here.

Local authority area *

I am a referrer that represents: *

Site type *

Patient's Date Of Birth *

Do the patient(s) have suspected or confirmed COVID 19 (High Risk) *

Patient's letter format *

Patient's preferred language *

If you would like to be notified by text if a match is not made then please supply a mobile number

Is this a return journey? *

Time when you need the volunteers until *

Number of volunteers required *

Additional information *

Please use the text box below to relay essential information to volunteers in the format suggested.

Please note that Steward Volunteers cannot assist with any clinical or administrative/clerical duties.

Please note that support will only be provided for a maximum of 4 weeks, after this duration you will need to place a new referral.

Priority *

Your details

First Name *

Last Name *

Email *

(You will receive an email verification link after your first referral, once you have confirmed this, you will receive your login details - Requests from NHS/Gov email addresses will then go live automatically, alternative addresses will need approval and may take up to 72 hours)

Contact Number *

Where did you hear about us? *

I confirm that the patient or organisation is aware of this referral and that I have permission from them to refer for support and for Royal Voluntary Service to use the information included in this form (including information about their health) for the purposes of providing support to them through the NHS Volunteer Responder Scheme.

YOU ARE ABOUT TO REQUEST A VOLUNTEER - THIS IS NOT A REGISTRATION FORM.

Royal Voluntary Service is a company limited by guarantee registered in England and Wales number 2520413 and a registered charity number 1015988 (England and Wales) and SC038924 (Scotland). Registered office: Beck Court, Cardiff Gate Business Park, Cardiff, CF23 8RP.