Register Form

Please fill in your details below. 
Pain Association Scotland takes your privacy seriously and will only use your personal information:

·      To provide you with information on the Association’s services.

·      To provide your GP, Pain Clinic or Referrer with information on your attendance at the Association’s groups or courses.

·      To improve our service and to contribute to research into chronic pain.

Under GDPR the details are for our records and therefore won’t be shared with anyone else.

A full copy of the policy can be found on our website.

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* 2. Title

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* 3. Full Name

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* 4. Address

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* 5. Phone Number

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* 6. Email Address

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* 7. Date of Birth

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* 8. Who were you referred by

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* 9. Please give details of who referred you and their address

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* 10. Consent: If you are happy to be contacted by the Association then please indicate below how you would like us to contact you

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