This referral has NOT been sent yet. You will be redirected to the listing's external referral form. Please complete the referral form there to submit the referral confirm Details Eye Care Liaison Officer by RNIB Who is this referral for? I am signing up myself I am referring someone else Service access criteria Tick to confirm you have checked the service access criteria "We have two ECLO's in Buckinghamshire -Amersham & Wycombe Hospital - Julie DennisStoke Mandeville Hospital - Laura FinnisYour ECLO would welcome referrals for anyone who:• Has any degree of sight loss, or is affected by sight loss. They may have a new diagnosis of a sight threatening condition, or had sight loss for a while. This includes family members, carers and friends.• Has been offered or considered for certification as sight impaired (SI) or severely sight impaired (SSI), or who meets the eligibility guidelines. This includes those who are newly certified, those who are unsure, and those whose certification status has changed (i.e. from SI to SSI).• Might benefit from emotional support. For example, anyone who appears to be upset or distressed, has not understood or taken in what you have said, or is expressing concerns about their future.• Might benefit from information about eye conditions.• Might need information about other support available, i.e. Sensory Teams, Vision Rehabilitation, and Services for Children with Vision Impairment (VI).• Needs general support and advice about aids or adaptations, mentions practical difficulties when at work or at home, or who has been referred to the Low Vision service.• Has sight loss and is at risk of becoming isolated (perhaps they have no support or family locally), are at risk of falling, or who appear to be frail.• Has sight loss and is of working age, whether they are in employment or not.• Would benefit from further information or support around treatment compliance, i.e. drops for glaucoma.• Has had a stroke or brain injury and has visual difficulties as a result.• Has been told that their sight has fallen below the level needed for driving.• Attends the eye department with sudden sight loss.• Is a child or young person with VI, and their families, who might benefit from a referral to VI Education Services or to a Qualified Teacher of Vision Impairment (QTVI).• Has sight loss and whose circumstances have recently changed (for example, their spouse has passed away).Please also consider any inpatients or those who have sight loss attending other wards or departments.01296 838390 or emailbht.eclo@nhs.net If the patient is not self-referring, please ensure you have the patients consent." Your Details Email Email is invalid We already have an account with this email. Please log in. Password Reset my password Log in First name Last name Your relationship to the person Organisation name Who are you referring? First name Last name Known as Date of birth Email Don't know / client doesn't have an email address Phone Address Line 1 Address Line 2 Town/City Postcode GP surgery NHS number Gender SelectFemale Male Transgender female Transgender male Non-binary Intersex Not specified Not known Other Additional referral details Do not enter protected health information (PHI) or any other personal data in these fields. What are the reasons for this referral? Sedentary lifestyle High body weight Finances Caring responsibilities Loneliness/isolation Employment Food Poverty Covid/Long Covid Mental health Substance misuse Transport Legal advice Managing a long-term health condition Day-to-day helping hand Victim of abuse Housing problem Bereavement Other: This field is required. Should the service provider be aware of any additional needs? Blind/partially blind Memory problem Hearing loss Housebound Does not speak English Poor mobility Learning and communication needs Physical disability Frail Other: Please share some brief details regarding this referral Confirmation and consent Tick to confirm you have gained consent to share this information with the service provider, your organisation and Joy Tick to confirm the service provider can directly contact the client Would you like to create an account? Make referrals faster next time you use Joy. Registered users can message service providers, submit reviews and track the progress of their referrals online. Password Weak password! Use at least 8 characters Use upper and lowercase characters (a-z) Use 1 or more numbers (0-9) Confirm password Please enter the same value again. required Submit Email: Password: Email
