You can become a member of Gloucestershire Hospitals NHS Foundation Trust by completing the below application form.
Fields marked with * are mandatory. 
First name *
Last name *
Middle name
Date of birth
We ask this question so that our system can calculate your relevant public constituency.
We won’t send you any communication via post.
  Please enter your postcode and click Get Address
Home address *
Town or City
Postcode *
We ask this question just in case there are any problems with your registration.
We won’t send you any communication via phone.
Contact number *
This is how we keep in touch with our members.
We are always conscious about the information we send to members and strive for quality not quantity.
As a member you will receive quarterly newsletters.
Email *
First Language
Ethnic Origin
Religion or beliefs
Sexual Orientation
Caring responsibilies
Relationship Status
Is this the gender you were assigned with at birth?