Want to arrange to speak to one of our Video Volunteers? - Northern Devon Healthcare NHS Trust

Our Video Volunteers are available to answer any questions you may have about accessing your outpatient appointment via video.

To request a phone call from one of our Video Volunteers please complete the form below:

Person details

Are you completing this form on behalf of someone else?

Yes
No

Please confirm you have their consent*

They consent

Title*

e.g. Mr, Mrs, Miss

First name*

Surname*

Contact telephone no.*

Your video appointment date*

What would be the best day/time for our volunteer to contact you?

Monday

Please tick all that apply

0900 - 1100
1100 - 1300
1300 - 1500
1500 - 1800

Tuesday

Please tick all that apply

0900 - 1100
1100 - 1300
1300 - 1500
1500 - 1800

Wednesday

Please tick all that apply

0900 - 1100
1100 - 1300
1300 - 1500
1500 - 1800

Thursday

Please tick all that apply

0900 - 1100
1100 - 1300
1300 - 1500
1500 - 1800

Friday

Please tick all that apply

0900 - 1100
1100 - 1300
1300 - 1500
1500 - 1800

Please read

By completing this form you are requesting a phone call from one of our Video Volunteers. Our Video Volunteers will only be able to offer support in how to attend your video appointment.

Our Video Volunteers cannot amend an appointment date or time – please contact the number on your appointment letter if you are unable to attend the appointment you have been given.

Our Video Volunteers cannot answer any clinical questions related to your appointment you must keep any clinical questions for your clinician.

Please tick confirm that you understand the type of support our Video Volunteers can offer and that you would like one of them to contact you.*

I understand

Name

This field is for validation purposes and should be left unchanged.