Signing up for Patients Forum If you are interested in becoming a member of the Patients Forum, please complete this form and click Submit. Title Mr Mrs Miss Ms Mx Dr Other First Names Surname Email Enter Email Confirm Email Mobile NumberAddress Street Address Optional Address Line 2 Optional Town Optional Post Code Optional Date of Birth Day Month Year Where are you registered? Charles Hicks Optional Roman Gate Optional Are there any issues or interests you would like us to know about, such as a reason for joining the Patients Forum or particular skills you can add? OptionalYour data will be used lawfully, in accordance with the Data Protection Act 2018, which gives you the right to know what information is held about you and sets out rules to make sure that this information is stored and handled properly. The Practice privacy policy can be viewed here.