Please fill in your details below to become a member of The Walton Centre NHS Foundation Trust

Fields marked with * are mandatory. 
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
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Email
Preferred method of contact 




Diversity Information
The Walton Centre aims to have a membership which reflects all of our patients. Completing the following three questions will help us achieve this and to support and understand your needs.
Your answers will be treated in the strictest confidence, and all data held will comply with the requirements of the Data Protection Act 1998 and the General Data Protection Regulation.
You can find out more about how the Trust hold and use your information at: https://www.thewaltoncentre.nhs.uk/318/your-information-your-rights-.html
Ethnicity
Sexual Orientation