LEWES COMMUNITY VOLUNTEERS

If you are filling out this form for someone else, please give your name here:

First Name

Surname

Address

Town

Postcode

Your Email Address

Your Phone Number

Please tell us what sort of support you require:

Shopping

My Shopping Request is Urgent

Please give us details of your shopping requirement, i.e. I only have 2 days of food left (please don't enter a shopping list here!):

How do you want to pay for your shopping:

Prescriptions

My Prescription Request is Urgent

Please select the pharmacy for your prescription:

If you selected 'Other' for pharmacy, please enter details here:

When will your prescription(s) be ready for collection?

How will you pay for your prescription?

Please give us any other relevant information about your presciption:

Physical Care

Foodbank (for those with very low finances)

Someone to talk to

Something to keep me occupied

Other

If you require support with anything else, please tell us briefly what issue(s) you are currently facing:

Data Protection Statement

Lewes Community Volunteers complies with its obligations under the "GDPR" by keeping personal data up to date; by storing and destroying it securely; by not collecting or retaining excessive amounts of data; by protecting personal data from loss, misuse, unauthorised access and disclosure and by ensuring that appropriate technical measures are in place to protect personal data. Your data will only be used by authorised persons working under the authority of Lewes Coronavirus Volunteers) View our Full Data Privacy Notice

Please confirm you have read our Data Privacy Notice.