Please use the form below to contact us about receiving care. Someone from the team will be back in touch shortly and will send you our waiver and a simple questionnaire so we may best assess your particular circumstances. Thank you.

Your personal details, and all other information given here and furthermore, is strictly confidential and will ONLY be shared among the VCC’s core caring team.

Please also note that we’ll not be able to assist you until these steps are accomplished. 

Only ‘Initiated Name’ and ‘Phone’ are optional; all other fields are required. Thanks again.