Join our Patient Network

Thank you for taking an interest in getting involved with our Trust activites. Please let us know a little more about you and we will be in touch as soon as possible.

You are not obliged to answer any demographic questions, although it will help us to ensure everyone is treated equally and to provide for any accessiblility needs that you may have.

If you would like to get in touch with us, please contact our Patient Advice and Liaison Service (PALS) on 01273 24292, or via email to sc-tr.pals@nhs.net.

1. Tell us about your age

2. What is your gender identity?

4. Which of these describe your ethnic background?

5. Tell us about a condition or disability.

	Yes	No	Prefer not to say
Do you have any physical or mental health condition or any illnesses lasting or expected to last 12 months or more?	Do you have any physical or mental health condition or any illnesses lasting or expected to last 12 months or more? Yes	Do you have any physical or mental health condition or any illnesses lasting or expected to last 12 months or more? No	Do you have any physical or mental health condition or any illnesses lasting or expected to last 12 months or more? Prefer not to say
Does your condition or illness(es) reduce your ability to carry-out day-to-day activities?	Does your condition or illness(es) reduce your ability to carry-out day-to-day activities? Yes	Does your condition or illness(es) reduce your ability to carry-out day-to-day activities? No	Does your condition or illness(es) reduce your ability to carry-out day-to-day activities? Prefer not to say

Join our Patient Network

Tell us about you.

1. Tell us about your age

2. What is your gender identity?

4. Which of these describe your ethnic background?

5. Tell us about a condition or disability.

6. Your religion or belief.

Join our Patient Network

Tell us about you.

1. Tell us about your age

2. What is your gender identity?

3. Is this different from the sex you were asigned at birth?

4. Which of these describe your ethnic background?

5. Tell us about a condition or disability.

6. Your religion or belief.