Verve Referral Form

Please complete this form with your referral agent

Why we ask you for the following information:

The information gathered will be collated by the coordinator of the Neighbourhood Renewal Health Improvement Project for Craigavon. This is so that you can be contacted and signposted to the most appropriate activity available through this project for your health and wellbeing needs.

How we treat your personal information:

Your personal information will be held securely in line with current data protection principles so that engagement in this project can be processed, monitored and evaluated.
For further information please see the SHSCT privacy notice

I consent to this referral being shared with the project coordinator who will assign a Health Trainer who will contact you to organise appropriate support

If you have any concerns you have a right to register a complaint with the project coordinator by emailing verve.network@southerntrust.hscni.net