Register

All fields marked with an asterisk (*) are required.

Registration

Thank you for your interest in Get Involved in Gloucestershire. By registering, you will be notified of ways in which you can get involved in our work and/or contribute to local Engagement and Consultation activities. The following form asks you to express your preferences for how we communicate with you and identify any particular areas and topics of interest. Registration is not compulsory, but it does help us keep you informed. If there are any questions you do not want to answer, you can select the "prefer not to say" option. Please be assured that in line with our Information Governance responsibilities, the information you provide when registering will be treated in confidence, kept securely and not shared with any individuals or organisations outside NHS Gloucestershire Clinical Commissioning Group.

Choose a screen name (this is what other users will see if you write a comment/join discussions online)

Please create a password (for your own use when logging into the site)

Passwords must be 8 to 16 characters and contain a combination of numbers and letters, with at least one lower case letter and one upper case letter.

Password confirmation

Name

Maximum characters 255

Address

Telephone Number

Maximum characters 15

Please tell us how we can contact you/share information with you.

Maximum characters 255

How might you want to get involved? (please tick all that apply)

Attending regular project meetingsJoining in with focus groups/workshopsResponding to surveysJoining online discussionsWorking with us to develop communications and patient information Working with us to prepare and give presentationsBeing in a short film (patient story)Encouraging others to get involvedOther (please specify)

Options are limited to

Please tell us about any other ways you would like to get involved?

Maximum characters 255

Please tell us why you want to get involved in shaping health and care services. Please include any further detail about your specific areas of interest.

Please let us know if you need any support to help you get involved, e.g. interpreters, Easy Read, carer support, etc

Are you a member of a community group/voluntary sector organisation/Patient Participation Group/political group?

YesNo Prefer not to say

Please tell us which organisation(s) or group(s) you are involved with.

About you

The following information helps us to know whether a wide range of people are "Getting Involved in Gloucestershire". This is not intended to capture information about all of the protected characteristics (as defined by the Equality Act 2010), as this information is routinely captured through our range of Engagement and Consultation activities.

Are you:

MaleFemalePrefer not to say

Do you identify with your gender as registered at birth?

YesNoPrefer not to say

If you have ticked other, please tell us more

Maximum characters 255

Do you look after, or give help or support to family members, friends, neighbours or others because of either long term health conditions (mental or physical) or problems related to old age? Please do not count anything you do as part of your paid employment.

YesNo Prefer not to say

Which best describes you?

A health or social care professional A community partnerA member of the publicPrefer not to say

I agree to the Terms of Use and Privacy Policy for using Engagement HQ