GoodSAM

I am a referrer that represents: *

Support Required *

You must select the correct support as this is matched to a volunteer with specific vetting for that role. An individual requiring shopping or prescription pick up is Community Support. A pharmacy/GP surgery/NHS site requiring the collection and delivery of many prescriptions/supplies is NHS Transport Support. IF YOU ARE UNSURE PLEASE CALL 0808 196 3382.

COVID Vaccination Steward Support: Volunteers will support the safe movement of patients around vaccination sites. They can monitor patient numbers, ensure safe social distancing, and identify patients who made need additional support. The maximum shift length is 6 hours. Check in and Chat Support: Provides short-term telephone support to individuals who are at risk of loneliness as a consequence of self-isolation. Check in and Chat Plus Support: Provides a regular check-in by telephone to the same individual for a duration of 10 weeks, with 3 calls taking place each week. Community Support: Provides collection of shopping, medication or other essential supplies for someone who is self-isolating, and delivering these supplies to their home. Patient Transport Support: Provides transport for patients who are medically fit for discharge or to support patients going to NHS appointments. We cannot accept requests for patient transport that involve wheelchair users. NHS Transport Support: Provides transport for equipment, supplies and/or medication between NHS services and sites. Also involves assisting pharmacies with medication delivery. Health & Care Non-Clinical Support Provides support by stewarding patients both internally (e.g. flu clinics, GP surgeries, pharmacies etc.) and externally (e.g. car parks, queues outside health clinics) within social distancing guidelines. Urgent Delivery Support: This can only be utilised for those requiring collection/delivery of Pulse Oximeters and/or Inhaled Budesonide for COVID-19 patients.

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 *

Priority *

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.