Want to arrange to speak to one of our Video Volunteers?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 detailsAre you completing this form on behalf of someone else? Yes NoPlease confirm you have their consent* They consentTitle*e.g. Mr, Mrs, MissFirst name*Surname*Contact telephone no.*Your video appointment date* DD slash MM slash YYYY What would be the best day/time for our volunteer to contact you?MondayPlease tick all that apply 0900 - 1100 1100 - 1300 1300 - 1500 1500 - 1800TuesdayPlease tick all that apply 0900 - 1100 1100 - 1300 1300 - 1500 1500 - 1800WednesdayPlease tick all that apply 0900 - 1100 1100 - 1300 1300 - 1500 1500 - 1800ThursdayPlease tick all that apply 0900 - 1100 1100 - 1300 1300 - 1500 1500 - 1800FridayPlease tick all that apply 0900 - 1100 1100 - 1300 1300 - 1500 1500 - 1800Please readBy 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 understandNameThis field is for validation purposes and should be left unchanged.Last updated: September 29, 2020
