Enhancing Patient Experience booking form

Name: (required)This field is required

Profession: (required)This field is required

Place of work: (required)This field is required

Email address:Please enter a valid email address

Phone number: (required)This field is required

Communications preference:

EmailPhone

What topics would you like your session to cover? (Tick as many as apply)

Younger patients (under 45)Older patients (over 70)Patients from the LGBTQ+ communityPatients whose first or preferred language is not EnglishPatients from a minority ethnic backgroundPatients who are digitally excludedPatients who have low literacy levelsPatients who are living on a low incomePatients who are rurally isolated or away from major cancer centres

Do you have any questions?

I would like to be notified when new sessions become available. (required)Please tick a checkbox

YesNo

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