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Apply to become a member of Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust

Complete the application by hand and send it in using the FREEPOST address on the form. You can also fax the form to us on 01942 822158

 

 

Forename*

Surname*

Date of birth* Please use dd/mm/yyyy format

Sex*

Address*

Postcode*

Tel No.*

Email*

Membership

Ethnic Group (Please select just one)

White

Asian/Asian British

Black/Black British

British Mixed Race

By submitting this form you are declaring that you are eligible to become a member of Wrightington, Wigan and Leigh NHS Foundation Trust and meet the legal minimum requirement. Members must be at least 16 years of age.

Data Protection Note This data will only be used to contact you about NHS Trusts or other health issues and will be stored and processed in accordance with the Data Protection Act. For further information on how we use your data please see the Trust's privacy notices available here: Trust Members Privacy notice

For Public Members: The register of Public Members is open for inspection by any member of the public. If you do not consent for your details to be inspected, please tick the box

Link to Royal Albert Edward Infirmary page
Royal Albert
Edward Infirmary
Link to Wrightington Hospital page
Wrightington
Hospital
Link to Leigh Infirmary page
Leigh
Infirmary
Link to Thomas Linacre Centre page
Thomas Linacre
Centre
Link to Community Care Locations page
Community
Services
Link to Patient Advice & Liaison Service page
Patient Advice
& Liaison Service

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Our Partners

  • Access Able
  • NHS
  • Three Wishes
  • Healthier Wigan
  • Greater Manchester Mental Health NHS Foundation Trust
  • Wigan Council
  • Healthwatch Wigan and Leigh
  • Macmillan
  • Fertility Fusion