Membership

1. Membership Number

Enter your Membership Number: (we need this to identify you)
 

2. Areas of interest (tick all that apply):

Accident & emergency

Meeting the needs of patients with learning disabilities

Access to services and discharge

Mental health

Cancer (please specify type if applicable)

Mixed sex wards

Care for the elderly

Orthopaedics

Children’s health

Pain management

Dermatology

PALS (Patient Advice & Liaison Service)

Diabetes

Pathology

Disabled facilities

Patient information

Gynaecology (women’s services)

Radiology services (x-ray, ultrasound, ct, mri)

Haematology (blood diseases)

Rehabilitation

Heart disease

Respiratory illness

Hospital cleanliness and the environment

Sexual health

Hospital food

Sight and hearing problems

Infection control

Stroke

Intensive Care

Surgery

Kidney diseases

The design of patient areas

Maternity services

Voluntary services

Others (please list)

3. How You Can Help
Please let us know how we can best find out your views if a topic comes up which you have indicated you are interested in. For example you may prefer to speak to someone on the phone, or communicate by e-mail, or you may wish to take part in a group discussion. Please indicate all that apply:

I would be happy to speak to someone on the phone

I would be happy for someone to e-mail me

I would be happy to receive information in the post

I would be happy to attend a meeting

I would be happy to attend a short series of meetings

I would like to sit on a group looking at issues in greater detail

I would like to be involved in other ways (please specify below):

4. Contacting You
We understand that our members may work full-time or part-time or may have regular commitments. Please indicate when you prefer us to ring you:

Morning (9am to 12noon)

Afternoon (12noon to 5pm)

Evening (5pm to 8pm)

5. Attending Meetings
Please indicate when you would prefer to attend a meeting

Morning (9am to 12noon)

Afternoon (12noon to 5pm)

Evening (5pm to 8pm)