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Please fill in the form below to join the Health Forum. If you would like a printed version of this form, please contact Paula Martin, Patient Engagement Officer, by calling 01206 918707 or emailing paula.martin4@nhs.net

The information you provide below will be used to contact you in future. If you do not wish to be contacted via any of these methods (eg. phone, text, email) please leave that particular line entry blank. We would prefer to have an email address. The privacy and confidentiality of your information is important to us. As an organisation we adhere to the principles of the Data Protection Act and NHS Confidentiality Code of Conduct detailed below.