Perinatal Mental Health Service User Database
If you have had experience of perinatal mental illness either as a patient, parent, family member, carer or friend and would like to participate in shaping the service, please complete the following questions.

Your contact details will be added to a database of service users and their families who are willing to help us in many ways.

The database is stored by the NHS Wales Health Collaborative on behalf of the Perinatal Mental Health Clinical Network Group (a group of professionals from across Wales who are working on improving services for perinatal illness).

Health professionals and researchers in Wales, who are working to develop services need to hear your ideas, suggestions and stories and will contact us. If you have let us know (on this form), that you are willing to work with them, information about their projects will be sent to you by the Perinatal Mental Health Clinical Network Group via email from PNMHNetwork@wales.nhs.uk . It’s then your choice, whether or not, you contact them to express an interest in being involved. The professionals developing the projects will not be supplied with your contact details.

The information that you complete in this form will be kept by the NHS Collaborative for a period of 3 years – it will then be deleted, or, we will contact you again to ask if we can keep your details on record for another 3 years. Your details can be removed from the database at any time by emailing us at PNMHNetwork@wales.nhs.uk and asking us to delete them.
 

1. Please select which activities below you would like to be involved with *

 

Please give the email address that you would be happy to be contacted on with information about projects for service development that you have identified you might be interested in *

 

2. Please provide your date of birth so we can involve you in appropriate activities relating to the service you experienced *

 

3. Which Health Board do you live within? *

 

4. Do you have your own transport? *

 

5. Would you be able to travel to other areas of Wales to take part in the activities you’re interested in? *