Hounslow
Clinical Commissioning Group
Help us to improve
the NHS in Hounslow...
Your Voice Counts!
Hounslow Clinical Commissioning Group (CCG)
commissions (buys and monitors)
healthcare services on behalf of everyone living in
the borough; every GP in Hounslow is a member
of the CCG. Your thoughts and experiences of
local healthcare services are important as they
help us to improve services, making them the
best they can be.
Become involved and we can send you
regular information. It is an opportunity
to share your experiences of using local
healthcare and:
P Keep up-to-date with developments in areas of health you are most interested in
P Be the first to find out about events, new initiatives, consultations and how to take part
P Help us understand the needs and wishes of local people when we are buying and monitoring services;
P Receive feedback on changes as a result of your feedback.
Title: Mr / Mrs / Miss / Dr/ Other – please specify:
Name/Organisation
Address
Post code
Email
Telephone
How would you like us to keep in touch with you?
Post Telephone/Text Message
Email (our preferred method as it costs less)
Areas of interest
Tell us which areas of healthcare you are most interested in. You will
receive general updates on the CCG as a whole but will be invited to
take part in work on these areas as they arise.
Circle all that apply:
Cancer
Learning Disabilities
Dementia
Long Term Conditions
GP Practices
Carer’s Wellbeing
Mental Health
Planned Care - tests, self-treatment and surgery
Children & Young People
Emergency or Urgent Care
Diabetes
Maternity Services
Long Term Conditions
Physical Disability
Elderly
/ Frail Care
Other – please specify
How would you like to be involved?
Complete surveys and questionnaires
Send me information on events and activities
I want to be involved in group meetings and discussions
I am happy to receive training to help the CCG decide which services to buy and monitor
Equality and Diversity
Monitoring
Under the terms of the Data Protection Act
(1998), Hounslow CCG ensures that any personal
information it gathers in the course of its
work is kept secure and only used for the stated
purpose of gathering the information
Please send to:
Engagement and Communications Manager,
Hounslow CCG, Sovereign Court,
15-21 Staines Road, Hounslow, TW3 3HR
October 2014