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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 enter below)
How would you like to be involved?	Find out more about the work of the Trust Take part in consultation of the Trust's plans Learn more about improving my own health, and be part of community health promotion campaigns Volunteer at the Trust Would like information on volunteering Give feedback on services Fundraising Planning for the future Consider standing for election as a governor Ok to share information with third parties Get involved in research at either the Trust, or our partner, the University of York.
What service areas are you interested in?	Gynaecology Radiology and Pathology Intensive care Renal Heart Disease Eye problems Accident and Emergency Endoscopy Haematology Children's services Asthma Pain management Cancer Respiratory Illness Rheumatology Sexual health Hearing problems Dermatology Ophthalmology Orthopaedics Anaesthetics Maternity Care Stroke Diabetes Urology Gastroenterology Care of the Elderly Breast Cancer Occupational Therapy Palliative Care Mental Health Physiotherapy Prevention Rehabilitation Services Public Health
How are you connected with the Trust?	A patient A carer for someone who is a patient Volunteer Have worked for the Trust No connection with the Trust Interested member of the public Current or former patient
How did you hear about Foundation Trust membership?	Online Application Face to Face Recruitment Through an employee of the Trust Onsite leaflet Media information

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Country	UK
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Do you consider yourself to be disabled?
How would you like to be involved?
What service areas are you interested in?
How are you connected with the Trust?
How did you hear about Foundation Trust membership?

Membership is also open to all your friends and family so get them to complete an application form today for each person to benefit from NHS discounts, members only newsletter and events.
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