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People’s Voices Group Sign-Up Form - Individuals

This is the form to join as an individual member which means representing your own views and/ or the views of someone you care for. We have a separate form for groups.

To be a part of the People’s Voices Group, you need to live or work in the Leeds area.

Please answer as many questions as possible, this makes it easier for us to link you to the opportunities that are most interesting and appropriate for you.

We recognise the sensitivity of some of this information and want to reassure you that it will be stored safely and confidentially on our secure database and it won’t be used it for any other purpose.

If you have any questions or need help completing this form, please contact us at:

Phone: 0113 8980035 
Email: info@healthwatchleeds.co.uk
Text: 07717 309 843

Your Details

Do you have any long-term conditions, impairments, or illnesses?
Please tick all that apply:
Do you have any of the following health conditions or have a particular interest in any of them?
Tick as many as apply. This will help us target what opportunities we share with you.
Do you or someone you care for have experience of any of the following?
Sometimes the opportunities that we want to share are targeted at people with particular life circumstances or experiences and the information you share will helps us get the right information to you. Please tick as many as apply.

Communication Preferences

 
We usually send opportunities to get involved by email to reduce the environmental impact and save costs. 
Please tell us if you need it in another way: 
Would you also like to sign up for the Healthwatch Leeds newsletter?

Consent

Privacy Policy
I confirm that I have read Healthwatch Leeds's privacy statement
GDPR
I consent to my personal information being stored in a secure database by Healthwatch Leeds for up to 10 years, in line with the General Data Protection Regulations, and that after 10 years, Healthwatch Leeds will ask me to reconfirm my consent to store my personal details, and check that I still wish to be a member of the People’s Voices Group. The database is shared by the five local Healthwatch organisations across West Yorkshire but only authorised staff and volunteers from Healthwatch Leeds will have access to the personal data supplied by you.
Consent to receive communications
I consent to Healthwatch Leeds using the personal information supplied above, to contact me by email, phone, text or direct message (or printed and posted communications if requested) about opportunities I may be interested in as outlined above.
I understand that I can unsubscribe
I understand that at any point, I can unsubscribe from the Healthwatch Leeds People’s Voices Group and Healthwatch Leeds will then remove my personal details from their database and no longer contact me as a member.
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