Please fill in your details to become a member of Lewisham and Greenwich NHS Trust
Fields marked with * are mandatory.
1. Personal Information
Member type
Public
Staff
Title
Unspecified
Mr
Mrs
Miss
Ms
Dr
Professor
Canon
Reverend
Wing Commander
Capt
Col
Major
Commodore
Cllr
Sister
Master
Dame
Lady
Mayor
Major General
Lord
Lord
First name *
Last name *
Middle name
Date of birth *
DD
MM
YYYY
Gender
Unspecified
Male
Female
Please enter your postcode, and click Get Address
Address *
Town or City
County
Postcode *
Country
Home telephone
Mobile
Email
Preferred method of contact
Email
Post
Telephone
SMS
Ethnicity
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
2. Additional Information
Special Postal Requirements
Large Print
Other formats
Disabilities
No
Yes
visual
physical/mobility
hearing
other (please specify)
Getting involved
Would like to join Public Group
Would like to join Service Users' Group
Receiving regular information about the trust
Attending meetings or events
Taking part in surveys, consultations or focus groups to help develop and improve services
Standing for election as a governor
Your interests
Community services
Emergency, in-patient and critical care (ICU) services
Services for older adults
Children's services
Services for teenagers
Women's services
Services for patients with disabilities
Cancer
Cardiac and vascular
Ear, nose and throat
Stroke
Chest disease
Gastroenterology
Diabetes & endocrinology
Haematology
Neurology
Sexual health services
Rheumatology and musculoskeletal services (including orthopaedic surgery)
Dermatology
3. Review
Member type
Last Used Services
Title
First name
Last name
Middle name
Date of birth
Gender
Address
County
Postcode
Country
UK
Home telephone
Mobile
Email
Ethnicity
Special Postal Requirements
Preferred method of contact
Disabilities
Getting involved
Your interests
4. Finish
*
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for full details.
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