Patient and Public Involvement

Name: *

Address: *

Tel No:

Email:

Once you have read our PPI leaflet and are happy to be involved in PPI, please decide from below the level of input you would prefer. Download Here

To be contacted by letter?

To be contacted by email?

To write a testimonial of your experiences?

To be asked specific questions? Either by telephone

by e-mail

by letter

To take part in Teleconferences (meetings by telephone)?

To be a member of our local PPI Group?

To be a member of our research study Writing Group?

To be a member of local Advisory Board?

To be involved in review of Scientific Papers?

To be involved in development of leaflets/literature?

To be a member of Patient & Public Involvement Focus Group?

These meetings (Groups) would be held twice yearly usually from 11am to 3pm. Lunch will be provided and travel expenses paid.

How often would you be willing to be available? (per year))

To be involved in contributing to the content of website?

A computer connected to the internet is required

To be involved in the planning of Conferences?

Manning a stall at Conferences/Events?

To speak at Conferences/Public events?

To have your Photo taken for use in our documents/leaflets?

Are you ?

a person with Dementia

Carer

Member of Public

Other (state below)

If you answered 'Other' above, please state

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Patient and Public Involvement