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Patient Involvement Forum sign-up form

Thank you for your interest in joining the General Osteopathic Council’s Patient Involvement Forum.

We ask a range of questions in our sign-up form, such as your age, ethnicity and gender because we want to ensure that our Patient Involvement Forum is as diverse as possible. If there are certain groups underrepresented, we would like to be able to promote participation in the forum among those groups.

Name and contact details

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What is your age?
Please select one
What is your sex?
Please select one
What is your ethnic group?
White

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Mixed or Multiple ethnic groups

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Asian or Asian British

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Black, African, Caribbean or Black British

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Other ethnic group

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Prefer not to say

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The Disability Discrimination Act

The Disability Discrimination Act defines a person is disabled if they have a physical or mental impairment which is substantial and long-term (ie has lasted or is expected to last at least 12 months) adverse effects on their ability to carry out day-to-day activities.

Taking this into account, do you consider yourself to be a person with a disability?
Have you visited an osteopath in the past 18 months?
Select one
If yes, how often do you visit an osteopath?

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Activities

Members of the Patient Involvement Forum are invited to participate in a range of activities. As a thank you for your time, expertise and skills, we offer participation fees for many of the activities outlined below. Reasonable expenses may also be considered for face-to-face activities. 

Please indicate the activities you would be interested in participating in (tick all options you are interested in)

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Additional support

Do you need additional support to participate in the Patient Involvement Forum? For example, we will produce materials in accessible formats on request.

Select one

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Verification

Please click the box to indicate you are a human rather than an automated system completing this form.

Last step

Thank you for taking part. We will be in touch as soon as possible.