Membership Application Form
Fields marked * are required
Do you consider yourself to have a disability? *
Do you consider yourself to have any other special requirements?
e.g. mobility, hearing loop, sight aids, interpreter?
Your Areas of Interest?
Children and families - Includes accident prevention service, children’s centres, contraception and sexual health service, school nursing, vaccination and immunisation services
Community services - Includes community matrons, continence service, dentistry, dermatology, district nurses, learning disabilities, musculoskeletal service, occupational therapy, physiotherapy, podiatry, speech and language therapy, wound care
Healthy living - Includes health promotion, healthy eating services, stop smoking service, weight management team
Long term conditions - Includes cardiorespiratory services, diabetes, dementia care, lymphoedema, pulmonary rehabilitation, rheumatology
Mental health - Includes child and adolescent mental health service, community mental health teams, crisis teams, early intervention service, eating disorder service, mental health inpatient services, social inclusion service, traumatic stress service
Specialist services - Includes acquired brain injury service, harm reduction service, prison health service, secure inpatient services, substance misuse service
As a member, what would you be interested in?
Would you be interested in standing for election to the Council of Governors? *
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