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Self 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.

Personal Information – Information About Carer

Information About Caring Situation

Information About Person Being Cared For

Information About Caring Situation And Caring Role Of Carer

Data Protection

Here at Voluntary Action Shetland (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. In order to provide carers with a better service we are now working in partnership with Shetland Care Attendant Scheme (SCAS). We will share your information with this organisation via a joint database. If you have any concerns about this please discuss this with us.

From time to time VAS / SCAS 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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