MS Ireland Physiotherapy Expression of Interest Form

About MSI Physiotherapy

Multiple Sclerosis Ireland offers a wide range of programmes that include:

Getting the Balance Right- These programmes are provided in most counties and funded by our branches or grants and fundraising and are coordinated by the local regional offices of MS Ireland. This is our Regional Exercise and Physiotherapy service which offers online and in person exercise classes, such as physiotherapy and yoga, across the country. They are usually delivered by local physiotherapists or yoga instructors working as contractors to MS Ireland.

MoveSmart- MS Ireland's online, nationally recruited, symptom-focused exercise program. Move Smart MS is delivered by a specialist senior neuro physiotherapist. Programmes are specialised, tailored, symptom-specific online exercise programmes for participants living with Multiple Sclerosis, grouped by age and stage in their MS journey.

ACTIVE NEURO services are divided into 4 geographical areas;

Physio West- For people living in in Galway, Mayo and Roscommon, we have a full time directly employed physiotherapist, who specialises in MS and other neurological conditions. The physiotherapist is supported by physiotherapy assistants to help deliver your care. We offer group and individual programmes online and in person .

Physio Dublin & Midlands - For people living in Southwest Dublin, Kildare and North Wicklow[SC1] , our service provides specialist neurological physiotherapy for people living with MS and other neurological conditions. Delivered by two Senior Neurological Physiotherapists, we currently offer online and face-to-face appointments, with additional exercise classes planned as the service continues to expand.

Physio Northeast – For people with MS and other neurological conditions in Monaghan, Cavan and Louth, we offer a one day per week service in Castleblaney with our specialist neuro physio. There are a limited number of individual assessments and group physio classes in person.

Physio Midwest – For People living in Clare, Limerick and N Tipperary we have a team of physiotherapists who specialise in MS and other neurological conditions. Programmes and assessments are online at present and will move in person when our new Midwest Centre opens in Spring 2027

How is my information managed?

This form will help us learn about you and what you would like to gain from this programme. Your information is input directly into MS Ireland's SalesForce systems and is only available to the MSI Physiotherapy team. You can decide against integrating your information with MS Ireland's membership database if you wish. However, to avoid unnecessary duplication within our database, your name email and date of birth 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 taking part in an MSI Physiotherapy program. They will not be able to see the other information you enter.

To help us find the programme that best matches your needs, please provide enter the following details.

GDPR and Consent - In order for MS Ireland 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

The first part of the data we collect will be used to ensure your safety and suitability to participate in MS Ireland programs. (Medical history, Medication list and Physical Activity Readiness Questionnaire). This data will be collected over the Zoom assessment or in person and is stored on our secure online servers and encrypted laptops.

The other data we gather will also be during an in-person discussion or an individual consultation using Zoom for healthcare. The questionnaires and information gathered will be used to evaluate the effects of the programme or to tailor the programme for you. You will complete the same questionnaires before and after the programme. We will also record information about how you are completing the programmes.

Your data will be stored on our secure Salesforce platform for 7 years after you finish the programme. Only the MS Ireland physiotherapy team will have access to your individual data.

The data in the questionnaires you complete before and after the programmes will be entered into spreadsheets and analysed as group averages with no sharing of individual data. The aggregated (and hence anonymous) data from all participants will be used in project reports or in presentations to professional groups or to health funders. We may ask if we can use your information for a case study and you can choose if this is anonymous.

Therefore, MS Ireland requires you to consent to the following:

I explicitly consent to MS Ireland processing information regarding my health for the provision of appropriate physiotherapy care and support.

I consent to the MS Ireland physiotherapy team creating and updating a file with my data

I consent to be assessed and treated by the physiotherapist or exercise personnel either in-person or using Zoom for healthcare

Yes - I consent to the GDPR policy outlined aboveYes - I am a healthcare professional/MSIreland staff member referring a person who has given their verbal consent for me to complete this form on their behalfNo - I do not consent to the GDPR policy outlined above

Please Note - Without your explicit consent, MS Ireland cannot proceed with the provision of this service