Expression of interest in the PPG

Please complete the patient participation form to express your interest in joining or contributing to the Patient Partnership Group.

We appreciate your interest in improving cancer care in the region and a member of the PPG will be in touch with you once you have completed your application form. If you haven't already seen it, more information is available here to explain about the work of the PPG and the responsibilities of its members.

If you would like an informal conversation about the role before applying please contact one of the co-chairs via this email address england.eoecancerallianceteam@nhs.net.

Name *Required

Address

Email address *Required

Phone number *Required

What appeals to you about becoming a member of the PPG? (Max 200 words) *Required

Please briefly outline any knowledge of cancer services and or specific tumour pathways in the region and how you have experienced these services e.g as a patient or carer or volunteer or other. (Max 200 words). *Required

Referring to the skills and qualities, describe your experience relevant to this role. (Max 300 words) *Required

Do you have any additional support needs that you would like help with to enable you to participate in this group? Please give details *Required

I agree to the privacy policy.

Expression of interest in the PPG

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