Patient Safety Network - become a member

First Name

Last Name

Email address

What is your role?

What seniority do you work at?

Name of hospice / organisation

If you select 'Other' at the bottom of the list, a free text field will appear for you to enter the name of your organisation.

By ticking the box below, you confirm that you would like to:

- Join our Patient Safety Network,

- Gain access to our online discussion group

Hospice UK will only use the data you provide on this form, for the purpose of the Patient Safety Network.

I confirm I would like to join the network

Patient Safety Network - join our community