East Kent Health Network

The Health Network is a virtual group of patients, members of the public and voluntary groups from across east Kent.

The network’s feedback helps our team of local GPs (the CCG) to decide how local health services are planned and designed. By becoming a member you can decide to participate as much or as little as you like.

You will also:

·         Receive our regular e-newsletters

·         Share ideas and views about local health services

·         Stay up-to-date with the health topics that interest you

·         Participate in focus groups, consultations and surveys about healthcare

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* 1. Name

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* 2. Please tell us your email address

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* 3. Please tick if you are signing up as:

A member of the public

Volunteer or work for an organisation

Organisation name

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* 4. Please tell us your gender

Male

Female

Transgender

Prefer not to say

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* 5. Please tick your age group

Under 18

18-24

25-34

35-44

45-54

55-64

65-74

75-84

85+

Prefer not to say

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* 6. Please tell us the first part of your postcode

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* 7. Please tell us your ethnicity or ethnic group

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* 8. Please tell us your health interest/s

Mental Health inc. Dementia

Urgent and Emergency Care

GP/Local community services

Maternity Services

Cancer Services

Long Term Conditions

Children and Young People

Other (please specify)

Thank you for taking the time to complete this form. If you have any questions or concerns, please email us: engage.eastkent@nhs.net