Volunteer Driver Request form
If you would like to request a volunteer driver to take you to a hospital or GP appointment, (Health journeys only) please complete the questions below. We advise you that you will be asked to wear a mask while you are seated in a volunteer car. Our volunteer drivers are not paid for the journeys that they undertake but are reimbursed at the rate of 45p per mile completed, starting from their house. The cost of the journey paid by the passenger is therefore 45p per mile plus an administration cost of £3 per journey. Paid in cash or invoicing is available by prior agreement with the transport staff
Person taking the details of booking *
Have you used the volunteer drivers before? *
What is your name? *
What is your postcode? *
What is the first line of your address? *
Please give us the telephone number that you would prefer us to contact you on: *
Have you been told by, or received GP advice suggesting that you or a member of your household are clinically vulnerable? *
Are you currently or have you in the last 14 days been suffering with any of the following symptoms? *
Required
Have you or a member of your household returned from outside the UK in the last 14 days *
What is the DATE of your appointment? *
What is the TIME of your appointment? *
Time
:
Where is your appointment? *
Which department? *
What is the approximate duration of your appointment?
Are you able to travel alone and Sit in the back seat of the car? And is anyone required to accompany you in the car? *
We can offer a "WAIT AND RETURN" journey, where our driver will wait for up to 2 hours at your appointment to take you home, or an "IN ONLY" journey where we simply take you to your appointment if you do not require to be taken home. What type of journey are you requesting? *
Do you use mobility aids, such as walking sticks, crutches or fold-able walkers? We can transport passengers who require any of the above, but currently we are unable to offer physical support to assist you getting into and out of your appointment. If you use a wheelchair, it will need to be folded and placed in the boot -We can only wheel you to reception and a porter will need to collect you and take you to your appointment *
Any additional information we may need to transport you safely?
Please notify us as soon as possible if you contract any Covid-19 symptoms or test positive for the virus within two weeks of using a volunteer driver
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