Request One-to-one support

If you'd like to speak to one of our trained volunteers, please complete this form. One of our Specialist Nurses will call you back to discuss the One-to-one support service. 

Please note, for confidentiality reasons, it must be the person who would like to use the service that completes this form. You should not complete the form on another person's behalf. 

We can also only offer this service to people who live in the UK.

Your details
Getting in touch
We will give you a call to discuss the One-to-one support service so please provide a number you are happy for us to call you back on.
Please tick the following boxes if you are happy for us to:
Please choose the days of the week on which it would be best to contact you:
The specialist nurse will call you back between 10am and 4pm Monday to Friday. If you contact us on a weekend, the specialist nurse will call you back the following Monday.
About you
Please tick any of the following that apply to you:
Privacy and confidentiality
By providing us with personal data, you consent to the collection and use of any information you provide in accordance with the above purposes and our privacy statement (link below). Any personal information supplied to the Specialist Nurses will be used for the purpose of dealing with your enquiry. We would only pass on identifying details in exceptional circumstances in order to comply with the law or the Nurses' Code of Conduct. For more information, see our confidentiality statement (link below).