North Staffordshire Combined Healthcare Listening and Engagement Active Listening Form

Please use the form below to submit a comment or suggestion to Combined Healthcare. We will review what you say to us and respond.

Give us a comment or make a suggestion to Combined Healthcare

Would you like to give us your name?*
We can only respond directly to you if you give us your name and e-mail address, but you can remain anonymous if you prefer
- Yes, I am happy to give you my name and e-mail
- I would prefer to remain anonymous
Name
First Last
Email
Job Title or Role (optional)
Organisation (optional)
Do you want to make a comment, make a suggestion or both?*
- I wish to make a comment
- I wish to make a suggestion
What comment would you like to make?
What suggestion would you like to make?
If you would also like to send us a file, you can do so by using the button below. Allowed file types are jpg, png, doc, xls or pdf. You can add up to 4 files - up to a maximum size of 50mb in total
Upload
Drop files here or

Accepted file types: jpg, png, doc, pdf, xls, Max. file size: 100 MB, Max. files: 4.
Can we send you news updates from time to time?*
- Yes, I am happy to receive news updates from Combined
- No, I would prefer only to be contacted in relation to my comments on this form
We would like from time to time to send you news updates about the work of Combined Healthcare? Are you content for us to do so?