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SWARM/South West London NHS sex worker vaccine self referral form

This is the self referral form for sex workers living or working in South West London to receive vaccination against Covid-19. All data is processed by a small team of sex worker outreach staff at SWARM. Only the name that you give us, your contact details, and your borough will be shared with the NHS for the purposes of vaccination. NO information will be shared with the police or home office. You do not need to be registered with the NHS, and you do not need to offer your legal name or address. *Translations* If you do not speak English, please email swlccg.swarm@nhs.net and we will provide a translator.

Use any name you would like. If you want your vaccination to be linked to your legal name, you can provide this here or directly to the NHS when you are receiving your vaccination.
Please provide either an email address or a phone number that you can be reached on. This is how you will be contacted to be offered a vaccination slot.
South West London Borough
Please choose the borough you live in, OR the South West London Borough that you work in most frequently.
Please provide some kind of proof that you are a sex worker
As we are only funded to provide vaccinations for sex workers, please provide a link to a website where you advertise, or other details of your work to allow us to verify you. This information will NOT be shared with the NHS, only with SWARM vaccine outreach staff who are all current sex workers. It will be deleted after the project has ended. If you would rather not share this information, please leave a phone number for a quick phone call with a staff member.
  • {name}
Would you like to receive information on other services from the NHS?
Would you like to receive information on accessing any of the following NHS services? - Help with registering with a GP - Mental Health Support - Sexual Health Services
Is there anything else that you would like to tell us?
  • {name}
Please tick the box below if you consent for your name and contact details to be passed on to the NHS for the purposes of offering you vaccination.

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