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Referral Form

The information you supply here is voluntary, the more info you supply us with the more we can tailor our communication to you.

Info regarding the person you are referring

Information about the person they care for

Referring professional

Privacy Statement

Here at VAS we take your privacy seriously and will only use your personal information to administer your account and to provide the products and services you have requested from us.

However, from time to time VAS would like to contact you with details of other services we provide. If you consent to us contacting you for this purpose, please tick to say how you would like us to contact you:

I'm happy for you to contact me by:

Where appropriate we would also like to pass your details onto Shetland Islands council and/or NHS Shetland and other third sector organisations who support carers and will pass information to you regarding being a carer or services to support the person you care for, so that they can contact you with details of services that they provide. If you consent to us passing on your details for that purpose, please tick to confirm:

I agree to share my information with:

I HAVE READ THE INFORMATION ABOVE AND I CAN CONFIRM THE DETAILS ARE CORRECT.
I HAVE READ AND UNDERSTOOD AND AGREE TO THE DATA SHARING NOTIFICATION.

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