PATIENT REFERRAL FORM



This is a live request for a volunteer - when submitting your first request you will receive a verification link to your email, once you have clicked this link you will automatically be registered and your referral will be live. All referrals after this will be live immediately.

If you are an approved referrer and would like to make a referral over the telephone, please call our Support Team on 0808 196 3382.

If you would like the individual to self-refer, please advise them to call a separate number - 0808 196 3646. Please note, this is only for individuals who meet specific criteria or who are considered medically vulnerable for another reason.


Please note a patient (hereafter referred to as client) could be an individual that needs support or a NHS service that requires volunteers providing they meet the referring criteria and would benefit from one of the 4 volunteer roles as determined by an approved referrer.

A referral form will need to be completed for each individual request eg if more than 1 volunteer is required or various types of support required.

Please ensure the client details reflect the name and location of where the support is required as this information will be sent to a volunteer.

- Please ensure you have read the instruction document.
- We cannot accept requests for patient transport that involve wheelchair users.
- Please use your dashboard to view and manage your referrals. You can view the status of each referral under your task status, including those that cannot be matched.
- Please note that we will process your personal data in accordance with our Privacy Notice - Referral Parties, which you can find here.




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.


(You will receive an approval 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)
  I confirm that the patient 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.