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Application form

This is the online application for the a picture of health public engagement events, which are the start of a project to involve the communities of Bexley , Bromley and Greenwich in how forthcoming changes in the health services should best work for patients.

What are these Events about? We are running a series of events in South East London to gather the views of residents of Bexley, Bromley and Greenwich on changes to their health services after recent decisions by the NHS and the Secretary of State, under a programme of change called a picture of health.

Who are the Events for? We are hoping to get views and ideas from two types of health service users: The Events: We are running two types of event (dates and times below):
Which Event should you go to?

Residents of each of the 3 boroughs can sign up for their local Out of Hospital Care event.

Residents of any of the 3 boroughs can sign up for morning Hospital Care session and women and parents for the afternoon Hospital Care event.


How do you sign up?

Please indicate which event you are interested in and then fill in the details below.


Where are the events being held?

The Hospital Care event for residents of all 3 boroughs will be held at Avonmouth House, SE1 6NX. The nearest tube stations are Elephant and Castle on the Bakerloo and Northern Line and Borough on the Northern Line.

For more information on the Hospital Care event please click here


The Out of Hospital event in Greenwich is being held at The Forum @ Greenwich, Trafalgar Rd, Greenwich SE10 9EQ.

For more information on the Hospital Care event please click here



The Events that are being held are:
- Event on Out of Hospital Care (including women's and children's) for Bromley residents in Bromley 15th July from 6pm
- Event on Out of Hospital Care (including women's and children's) for Bexley residents in Bexley 22nd July from 6pm
- Event on Out of Hospital Care (including women's and children's) for Greenwich residents in Greenwich 28th July from 6pm
- Event on Hospital Care held in Southwark for Bromley, Bexley and Greenwich residents on the 27th July 2009 10 am- 2 pm
- Event on Women's and Children's Hospital Care for Bromley, Bexley and Greenwich residents held in Southwark on 27th July 2009 1 pm – 4 pm


For more information, please click here to download the a picture of health information sheet
Please tell us which borough you live in:
Borough:
Bexley
Bromley
Greenwich
Please indicate which involvement event you would like to attend:
Event on Out of Hospital Care (including women's and children's) for Bromley residents in Bromley 15th July from 6pm
Event on Out of Hospital Care (including women's and children's) for Bexley residents in Bexley 22nd July from 6pm
Event on Out of Hospital Care (including women's and children's) for Greenwich residents in Greenwich 28th July from 6pm
Event on Hospital Care held in Southwark for Bromley, Bexley and Greenwich residents on the 27th July 2009 10 am- 2 pm
Event on Women's and Children's Hospital Care for Bromley, Bexley and Greenwich residents held in Southwark on 27th July 2009 1 pm – 4 pm
Your Details
Your Name:
Address:
Town:
County:
Postcode:
Phone Number:
Mobile Number:
Email address:
Do you have any Special Requirements for attending the Meeting?
Dietary Needs:
Other Needs:
(e.g. disabled access, language interpreter, signer)
If you have been nominated by an organisation
Organisation's name:
Their Postcode:
Your Demographics
Ethnic group:
White
Asian or Asian British
Black or Black British
Chinese
Other (please specify)
Prefer not to say
Sex:
Male
Female
Prefer not to say
Age:
16-29
30-44
45-59
60-74
75+



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