Patient and Public Involvement for Infectious Diseases at St George's

Thank you for your interest in joining our Patient and Public Involvement Panel for Infectious Diseases at St George’s Hospital and University of London.

Please kindly read:

our patient information sheet (Word) about what opportunities being a member of the panel provides
our privacy notice (Word) about how any data you give us will be used.

Register to join the Patient and Public Involvement Panel

Complete the short form below to join the Patient and Public Involvement Panel for Infectious Diseases at St George’s Hospital and University of London.

Your details
Name

First name

Last name
Date of birth
Email
Phone number
Gender
The following question on gender is optional and is only being asked in order to help create a representative Patient and Public Involvement Panel. You do not have to answer if you do not wish to.
What gender do you identify as?
Other
What is your ethnic group?
The following question on ethnicity is optional and is only being asked in order to help create a representative Patient and Public Involvement Panel. You do not have to answer if you do not wish to.
White
Mixed or multiple ethnic groups
Asian or Asian British
Black, Black British or Caribbean
Other ethnic group
Education
The following question on education is optional and is only being asked in order to help create a representative Patient and Public Involvement Panel. You do not have to answer if you do not wish to.
What is the highest level of education you have completed?
Other
Declaration
By selecting the field below you confirm your agreement with the following: I consent for my personal contact information as above to be electronically stored at St George’s University of London for the purposes of the Patient and Public Involvement Panel. I consent to being contacted by approved Doctors and Scientists at St George’s, University of London. I understand I may withdraw consent for membership of the PPI panel at any time and do not need to give a reason why.
Please confirm that you agree with this declaration
I agree
If you require further information, please email IICAGPPIenquiry@sgul.ac.uk. Once you submit your answers you will be sent an automatic confirmation email with additional information on how to contact the team for enquiries and/or withdrawing consent.

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Patient and Public Involvement for Infectious Diseases at St George's

Register to join the Patient and Public Involvement Panel