Next Steps with MS - Screening Form

Welcome, and thank you for your interest in our Next Steps with MS Support Session (1:1 Zoom)

This form will help us tailor your session. These sessions are for people who have been diagnosed with MS within the past 2 years.

What the session includes:

A supportive, one-to-one Zoom appointment with an MS Ireland nurse

A focus on early symptoms, lifestyle, and self-management

Signposting to MS Ireland services and trusted resources

Each session lasts around 45 minutes, and one session per person is offered at this time.

After you submit this form, we’ll respond within 2 working days to offer a time and date for your session, or to recommend another support option if more appropriate.

Please Note.

This is not a clinical consultation, and we do not provide treatment recommendations or crisis support.

If you are experiencing severe or urgent symptoms, please contact your GP or MS nurse directly.

After submitting the form, we’ll review your responses and get in touch to offer a session time — or direct you to the support that best suits your needs.

We’re here to support you as you take your next steps with MS.

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

MS Ireland is committed to protecting your personal data. The information you provide in this form will be stored securely in MS Ireland’s internal systems and will only be accessible to relevant staff involved in delivering this service.

Your name, date of birth, and contact information may be visible to other MS Ireland staff to avoid duplication in our system.

This information will not be shared with any external organisation without your explicit consent unless required by law or in the case of risk to you or others.

You have the right to access, correct, or delete your data at any time by contacting info@ms-society.ie.

By ticking below, you consent to: