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Register for Westmead Engagement Project

Register for Westmead Engagement Project

Westmead Hospital would like your involvement on how we can continually improve our hospital.

We're looking for enthusiastic patients, carers and members of the local community to participate in our Consumer and Community Engagement Project.

If that sounds like you, please register your interest by completing this form.

Registration form - Westmead Hospital Consumer and Community Engagement Project

Name:* - required

Organisation: (if applicable)

Unit/house no:

Building:

Street name:

Suburb:

State:

Postcode:

Email:

Phone:* - required

How would you like to participate? Please tick all that apply

Join peak hospital committee as a consumer representative

Provide patient/carer story in our staff orientation

Contribute to service planning

Participate in planning for the redevelopment of Westmead Hospital

What is your area of interest? Please tick all that apply

Women's health and birthing services

Oral health

Renal services

Patient safety and quality

Cardiac/stroke/respiratory care

Medication safety

Emergency services

Cancer services

Aged care

Corporate/support services

Other

If Other, please describe:

Tell us about yourself: please tick all that apply

Male

Female

Patient

Carer

Person with a disability

Community representative

Consumer advocate

Aboriginal & Torres Strait Islander

Stakeholder: government agency

Stakeholder: NGO

Speak language other than English at home

Which language(s)?

Is there anything else you would like to tell us?

General Comments:

Mandatory field(s) marked with *

Privacy Agreement

The information we are collecting from you will be used by WSLHD staff for the sole purpose of facilitating your engagement with us. Your personal information will not be used by WSLHD for any other purpose and we will not disclose your personal information to any person or organisation outside of WSLHD. Your personal information will be securely stored in the Community and Consumer Engagement Unit of WSLHD.