Instruction

Basic instructions on using portal forms

We need to collect information in this form so that we can understand what help you (or the person) may need. If we cannot cover all your needs, we may need to share some of this information with other organisations, so they can help us to provide the services you need.

We will treat your information as confidential. We will only share it with other people when it is necessary to do so, and the law says we can. This may be to provide a service or to keep you or someone else safe from harm. If there is no legal reason to share your information but we think it might help you if we do, we will ask you first.

Anonymised data from your record may also be used to help us monitor and improve services in the future. More information about how we may use your personal data is included in our privacy notice

Do you consent to share your information? * This field is required

Yes

Is there anyone you do not want us to share information with? * This field is required

Yes

You can complete this form for yourself or on behalf of someone else i.e. if you are a Carer, Relative of Friend.

How to Navigate

Click on the numbered sections on the left hand side of the window

or

use the Next button

and

options to move through the pages.

Do not use the Browser 'Back' button

Progress

When progressing through the form, the progress bar will show you how far through completing the form you are.

Horziontal Progress bar showing 33 percent complete

The Form

Questions

You DO NOT need to answer every question, you need only complete what is relevant.

The form uses many different types of questions, including lists and text fields

Select the option(s) that best describe your situation.

This symbol Red asterisk

indicates that the question is mandatory and must be answered in order to continue.

Options

Save the Form

Use the

option to Save the form to return to at any time.

Print the Form

Use the

option to Print a copy of the form if required.