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Please fill this form to add a short dedication which will appear on the  virtual Reflection Wall.

This document is available in Welsh / Mae’r ddogfen hon ar gael yn Gymraeg:
cliciwch yma.

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* 1. Message

Question Title

* 2. Please add your name or initials

By completing this form, I agree that the information on this form can be shared on the Cardiff and Vale University Health Board Reflection Wall. I also agree to the Health Board's Terms of Use.

Thank you.
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