If you are an employee of the Trust you will automatically become a member (unless you choose to opt out) and so you do not need to complete this form. Our preferred method of contact is by email and you are required to provide an email address when registering online. Please note that you must be 16 years or older to join.

You can become a patient member if you are 16 or older and have been a patient or carer at either Chelsea and Westminster Hospital or West Middlesex Hospital in the past three years.

You can become a public member if you are 16 or older and live in one of the following boroughs:

     Royal Borough of Kensington and Chelsea
     City of Westminster
     London Borough of Hammersmith and Fulham
     London Borough of Wandsworth
     London Borough of Richmond upon Thames
     London Borough of Hounslow
     London Borough of Ealing

Fields marked with * are mandatory. 
Member type
First name *
Last name *
Date of birth *
  Please enter your postcode and click Get Address
Address *
Town or City
Postcode *
Home telephone
Email *
Preferred method of contact 

You do not have to complete this part of the form but it helps us to ensure we represent all sections of the community.
Ethnic group