Member type	Public Staff Patient
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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

In the last 12 months as a Trust member have you been involved in any of the following:	Read the patient focus magazine online Read a printed copy of the Patient Focus magazine Attended the Annual General Meeting Attended a member's event Encouraged a friend, family member or work colleague to join as a member Voted in a Council of Governors election None of the above Other, please state
Do you consider yourself to be disabled?	No Yes A sensory disability A physical disability A learning disability A mental health problem Any other special need (please list in the 'Notes' section)
How would you like to be involved?	Consider standing for election as governor Attend or speak at trust committees Being available to sit on a website user group Commenting on general hospital patient information Attending events run by the Charity Giving your views on possible changes to the Trust clinical service Inputting into service design\redesign Learning more about being a member of a `Patient Panel’ to provide feedback on my experiences Take part in consultations & surveys of the Trust's plans. Volunteering at the Trust (such as greeting visitors, administration work or patient befriending)
Service preferences?	Congenital Heart Disease Coronary Artery Disease Heart Valve Disease Cardiac arrhythmias Critical Care Other cardiac disease Cystic fibrosis Asthma Chronic Obstructive Pulmonary Disease Interstitial Lung Disease Other Respiratory Disease Transplantation
How are you connected with the Trust?	Current or former patient (within the last 3 years) Carer of a current/former patient (within the last 3 years) Interested member of the public Member of the RBH & HH Alumni
How did you hear about the Trust?	Patient Mailing Radio advertisement Through an employee of the Trust

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
In the last 12 months as a Trust member have you been involved in any of the following:
Preferred method of contact
Do you consider yourself to be disabled?
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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