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* 1. Name

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* 2. Email address

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* 3. Making a short video - please select one option

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* 4. What other actions might you be willing to take during the campaign? This doesn’t commit you to anything, but it will be very helpful for us to have an idea.

Thank you for expressing your interest in the Patients Association's general election campaign. If you complete this survey by clicking 'Done', we may send you a small number of emails giving you further information about how to get involved. These will be in addition to any other regular emails you receive from us. If you don't want to receive these emails, close this window and don't complete the survey.

If you have any questions on the campaign or would like to get in touch about anything else, email policy@patients-association.com

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