MSIreland Care Centre - Expression of Interest

MSIreland Care Centre - Expression of Interest

The MS Care Centre is the only dedicated respite centre for people with multiple sclerosis in Ireland and is a place for residents to learn more about their MS and find ways to self-manage their condition.

It offers short-term respite care to people with MS and other neurological conditions, therapeutic services, neurological assessments and many social activities in a homely environment in the suburbs of Dublin. Our ‘home away from home’ is a place of rest and relaxation for people from all over Ireland.

How is my information managed?

This form will help us learn about you and what you would like to gain from respite. Your information is input directly into MS Ireland's SalesForce systems and is only available to the respite team. You can decide against integrating your information with MS Irelands membership database if you wish.

However, to avoid unnecessary duplication within our database, your name, email and date of birth only will be visible to all MS Ireland staff. If you are already a member of MS Ireland, your regional office will be able to see that you are availing of respite. They will not be able to see any other information.

Please provide enter the following details:

Your First Name

Your Surname

Preferred Phone

Mobile PhoneFixed-line Phone

Phone

Mobile Phone

Email Address

Age

Your own name and email address (HSE Personnel)

Which branch or region?

Do you consent for this information to be stored on MS Ireland’s SalesForce Server and processed by the MSIreland Respite team – only the Respite team will have access to this information

YesNo

How long is it since your diagnosis of MS?

GDPR and Consent - In order for the MSIreland Respite Team to comply with current General Data Protection Regulations (GDPR) we are required to obtain your formal consent to gather and use information about you. Under this regulation MS Ireland must adhere to the following:

· Valid consent must be explicit for the data collected and the purposes the data is used for

· The consent does not imply consent forever

· The data must only be used for the purpose it was initially intended for and no other

Following your expression of interest a member of our team will be in touch with you regarding completion of a reservation form. The reservation will be completed by you and your GP. The reservation form will only be viewed by the respite team to determine your suitability for respite.

Your data will be stored in secure offices and on encrypted laptops (based at MS Ireland, 65 Bushy Park Rd, Rathgar, Co. Dublin).

I consent to the MS Ireland Respite Team collecting, processing, analysing, and storing the data associated with providing me with respite.

I consent to the M S Ireland Respite Team creating and updating a file with my data

Yes - I consent to the GDPR policy outlined aboveNo - I do not consent to the GDPR policy outlined above

Thank you for completing this form which will be reviewed shortly by the MSIreland Respite team

Contact Information