Informizely customer feedback surveys

[Skip to content]

Southern Health
Search our Site

Become a member

Becoming a member of our Trust is quick and easy. To apply online, just fill out your details in the form below. If you have any trouble in filling out this form, or have any questions or queries, then please don't hesitate to contact us.

Mandatory field

Foundation Trust Membership Application Form
Section 1: Your Contact Details
Do you have any special information requirements?
Section 2: Making The Most Of Your Membership
What level of involvement do you want to have with the Trust?
Which of our services are you most interested in? Please tick all that apply.
Section 3: About You
The data you give will help us see if our Membership is representative of our local communities.
(You must be at least 14 years old before you apply for Membership.)
Are you...
How would you describe your ethnicity?
Knowing about your disabilities or special needs could help us to communicate with you better. If you are happy to share details, please provide more information.
Would you describe yourself as having any of the following:
Section 4: Data Protection and the Public Registers
The information you give us will be used for Foundation Trust business only. Your name will be included on a public list for the purpose of managing membership, unless you tell us not to.
If you do not want your name to be included on the public list, please tick this box.
Section 5: Declaration
I want to be a Member of the Southern Health NHS Foundation Trust. I am not a member of Staff. I am happy for you to use this information.
If you are under 16, please talk to a parent or guardian about joining the Foundation Trust.
For extra security, please enter the characters as you see them in the box below.