Share Your Story - St Gemma's Hospice

Your Details

Name

First Last

Address

Street Address Address Line 2 City County Post Code Country

Phone

Email

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Your Story

My relationship to St Gemma’s

Please select all that apply

I am a patient
Someone I know is/was a patient
I am a volunteer
I am a staff member
Other

Area of care you or your loved one experienced

In-Patient Care
Day Services
Community/Care at home
Bereavement/family support

Please select all that apply

Please enter your job title

What is your volunteer role?

Your Name*

This is how your name will appear publicly

Your Loved One's Name

Your Story*

Please tell us about your experience. Share as much or as little as you feel comfortable with.

Picture

Accepted file types: jpg, jpeg, png, gif.

File must be one of the following formats: jpg, jpeg, png, gif.

Your words and photo will appear on the St Gemma's Hospice website*

I understand that by sharing my story, I give my permission for St Gemma's Hospice to reproduce my words and picture in their marketing materials, elsewhere on the St Gemma's website, St Gemma's social media channels and on other marketing channels, including printed materials.

Are you happy to be contacted by St Gemma's for further information regarding your story?*

Yes
No

How we communicate with you

As a valued supporter we really want to keep you posted about news and events across St Gemma’s and to share how your support benefits local patients and their families. We will contact you for administrative purposes regarding this interaction. We will usually send you information by post; if you would also like to receive email updates please let us know. If you wish to change how we send you information or choose not to hear from us at all, there are a variety of ways you can do this. Ring us on 0113 218 5555, email supportercare@st-gemma.co.uk or update your preferences online at www.st-gemma.co.uk/mydata. For further information on how we use and store your details please visit www.st-gemma.co.uk/privacy. We will never sell your personal information.

I am happy to be contacted by email in the future:*

Yes
No

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