Update your membership details

Because we hold personal information about you, we need to periodically check that you still want to hear from us and that the details we hold about you are correct.

Please complete this form to confirm your details and to add information about your interests in our work. Questions marked * must be filled in to be able to complete and submit the form.

Thank you.

If you have any questions, please email mailbox@patients-association.org.uk

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* 1. Your title

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* 2. First name

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* 3. Last name

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* 4. Your email address

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* 5. Please confirm your email address

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* 6. Your phone number

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* 7. Your address

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* 8. Your postcode

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* 9. How would you describe yourself? Please select only one

I am a patient

I am a carer

I am someone with an interest in health and social care

I am a health professional - if you choose this answer please answer Q10 to choose which profession

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* 10. If you selected health professional in Q9, please let us know your profession.

Primary care nurse

Community nurse

Health visitor

Hospital doctor

Hospital nurse

Midwife

Dentist

Pharmacist

Optician

Other - please describe

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* 11. How did you hear about us?

Newspaper or online media

Social Media e.g. Twitter, Facebook etc

TV or radio

Conference or event

Met a representative of the charity

Word of mouth

Google or other internet search

Patients Association Helpline

Care Quality Commission

Not sure/can't remember

Other (please specify)

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* 12. We would also like to keep in touch with you from time to time to let you know about the difference that your support is making, as well as giving you opportunities to get involved with patient surveys, fundraising, volunteering and our campaigns. Please select all that apply.

I am happy to be contacted by email

I am happy to be contacted by post

I am happy to be contacted by telephone

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* 13. Tell us what interests you and we’ll make sure to let you know when we have projects that might interest you. Select as many as you like from the list below.

Carers

Engagement of patients in decisions about their care

Funding and sustainability of health and social care

Health inequalities

Partnership with patients

Patient safety

Prevention and public health

Technology, including digital, and health and social care

Using and accessing health and social care

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* 14. Please let us know if you would like to receive Weekly News, our enewsletter, via email.

Yes

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* 15. Please let us know if you’d like to receive our membership magazine Patient Voice by email

Yes

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* 16. Would you be interested in fundraising or volunteering with us?

Yes

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* 17. What was your main reason for joining the Patients Association?

Thank you for updating your details. We're very grateful for your continuing support.

As part of this update we invite you to complete an anonymous questionnaire about your background.

Details of our privacy policy are available on our website.