Member type Please select your category from the options listed	Public Patient
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The trust is committed to saving money on printing, paper and postage and therefore only communicates regularly with members via email.
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Ethnic Origin	Not stated White - English, Welsh, Scottish, Northern Irish, British White - Irish White - Gypsy or Irish Traveller White - Other Mixed - White and Black Caribbean Mixed - White and Black African Mixed - White and Asian Mixed - Other Mixed Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Asian or Asian British - Chinese Asian or Asian British - Other Asian Black or Black British - African Black or Black British - Caribbean Black or Black British - Other Black Other Ethnic Group - Arab Other Ethnic Group - Any Other Ethnic Group
Religion/Belief	Not Stated Atheism Buddhism Christianity Hinduism I do not wish to disclose my religion/belief Islam Jainism Judaism Other Sikhism Undefined
Sexual Orientation	Not Stated Heterosexual or Straight Gay or Lesbian Bisexual Other sexual orientation not listed Not Sure Prefer not to say

Special Postal Req	Large Print
Voting Preference	Electronic Voting (go green and also save the Trust vital funds) Paper Voting
Disabilities	No Yes A sensory disability A physical disability (mobility) A learning disability Mental Health Any other special need (please list in the 'Notes' section) Hearing Impaired Sight Impaired
How would you like to be involved?	Find out more about the work of the Trust General Trust news Information regarding research Interested in attending Medicine for Members Interested in attending public Council of Governors meetings Interested in attending the Annual Members Meeting Fundraising Take part in consultation of the Trust's plans Volunteer at the Trust Interested in being a Governor
Service preferences?	Adult Mental Health Service Allergy Service Audiology Service Bariatric Surgery Service Behind the scenes of the hospital Blood and Marrow Transplantation Service Breast Surgery Service Cardiac Surgery Service Cardiothoracic Surgery Service Cardiothoracic Transplantation Service Clinical Genetics Service Clinical Haematology Service Clinical Oncology Service Colorectal Surgery Service Community Sexual and Reproductive Health Service Dental Medicine Service Dermatology Service Diabetes Service Dietetics Service Ear Nose and Throat Service Eating Disorders Service Elderly Medicine Service Emergency Medicine Service Endocrinology Service Gastroenterology Service General Surgery Service Gynaecology Service Haemophilia Service Hepatobiliary and Pancreatic Surgery Service Infectious Diseases Service Intensive Care Medicine Service Interventional Radiology Service Issues affecting our workforce Learning Disability Service Midwifery Service Neonatal Critical Care Service Neurology Service Obstetrics Service Occupational Therapy Service Ophthalmology Service Outpatient services Paediatric Service Pain Management Service Palliative Medicine Service Physiotherapy Service Plastic Surgery Service Podiatry Service Post-COVID-19 Syndrome Service Prosthetics Service Rare Disease Service Renal Medicine Service Rheumatology Service Speech and Language Therapy Service Spinal Injuries Service Spinal Surgery Service Stroke Medicine Service Thoracic Surgery Service Transplant Surgery Service Trauma and Orthopaedic Service Trauma Surgery Service Tropical Medicine Service Upper Gastrointestinal Surgery Service Urology Service Vascular Surgery Service Well Baby Service
How are you connected with the Trust?	A patient past or present A carer of someone who is a patient Have worked for Trust in the past Live in the local area
How did you hear about the Trust?	Online Application Other (please list in 'Notes') Patient Mailing Face to face recruitment Through an employee of the Trust Patient information screens Leaflets Newsletter Media Trust website (www.cuh.org.uk)

Member type Please select your category from the options listed
Last Used Services
Title
First name
Last name
Middle name
Date of birth
Gender
Address
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Country	UK
Home telephone
Mobile
Email
Ethnic Origin
Religion/Belief
Sexual Orientation
Voting Preference
Special Postal Req
Disabilities
How would you like to be involved?
Service preferences?
How are you connected with the Trust?
How did you hear about the Trust?

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