Please fill in your details below to become a member of Sussex Community NHS Foundation Trust.

Applications from those aged 12 to 15 years need to be countersigned by a parent/guardian and cannot therefore be processed online. You can download a printable form here or you can email us to request a form.


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




Ethnicity
Faith
Sexual Orientation
Do you, or have you ever considered yourself as Transgender?