GoodSAM

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Please select the type of support you require: *

Telephone Support Community Response In Home Support

Please select the activity type required for this support: *

Check In and Chat Call

Support Info: Collection and delivery of essential shopping, prescriptions, or lateral flow tests to people at home. Alternatively, accompany the person to an activity in the community.

Support available on a one-off basis or a period of up to 6 weeks.

Volunteer Checks: Volunteers undertaking these tasks have completed an ID Check and an enhanced DBS check with adult barred.

Please select the activity type required for this support: *

Shopping - small shop

Shopping - larger shop

Pharmacy - collection/delivery

Connect - accompany to an activity

Support Info: Volunteers provide companionship to a person and encourage them to engage with activities at home such as hobbies, leisure activities and past times.

Volunteer Checks: Volunteers undertaking these tasks have completed an ID Check and an enhanced DBS check with adult barred.

Please select the activity type required for this support: *

Companionship Visit (e.g. social activities)

Please select the reason for this activity support: *

To alleviate loneliness or grow social contact.

Due to recent discharge from hospital.

Due to pending admission to hospital.

Not applicable.

Other, please specify.

Practical task information: *

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Your details

First name: *

Last name: *

Email address: *

Contact number: *

Job title: *

Relationship to client: *

Client details

First name: *

Last name: *

Address 1: *

Address 2:

Town: *

Postcode: *

Date Of Birth: *

Email address: *

Contact number: *

Information letter format *

Preferred language: *

Declarations

Consent: *