Membership Application – Barnabas Patient Voices

Please complete all the following information *

I wish to join Barnabas Patient Voices. *

Name *

Email *

Email

Confirm Email

What is Your Relationship to Barnabas Medical Centre? *

Patient
Carer of a Patient
Staff Member

Patients & Carers: Which Doctor or Nurse did you last talk to at Barnabas Medical Centre?

Your Postcode *

Group Rules *

I confirm that I have read and understood the Group Rules and Privacy Policy

The Group Rules may be found at https://barnabasvoices.org.uk/barnabas-patient-voices-group-rules/.
The Group's Privacy Policy is at https://barnabasvoices.org.uk/privacy-policy/.

Consent *

I consent to Barnabas Patient Voices storing my details to register my membership.

The above information is required for membership, however only the data in the required fields will be retained.
For patients and carers we will from time to time check your your details with the Practice's list of registered patients.

We will email you when your membership has been approved.
If your membership is declined, you will be told why and all your submitted information will be deleted.