[restrict] You are already a member and signed in.

Enjoy!

[/restrict]

[not_logged_in]

Join Active Patients

As a patient powered community, the greater our membership the greater the influence we can have; from helping other patients and their families, to engaging with healthcare communities and policy makers.

So we’d love you to join us. We can send you relevant content, and regular updates about our group and are here to answer any questions and share your stories.

Membership Level

You have selected the Join Active Patients membership level.

The price for membership is $0.00 now.

Account Information Already have an account? Log in here

Username

Password

Confirm Password

I am a ...

First Name

Last Name

Country

Postcode

Your Hospital Name (if applicable)

Your Hospital Town/City (if applicable)

Your Interests

How did you hear about Active Patients?

Condition of interest (optional)

e.g. Heart valve disease

Treatment of interest (optional)

e.g. Heart surgery

Procedure of interest (optional)

e.g. Heart valve replacement

Date of procedure (optional)

Yes, sign me up as a member of Active Patients.
I understand that my personal information will be used for the purposes of my membership and confirm that the personal data I have entered on this form is my own.

Yes, I would like to receive regular updates from Active Patients.
From time to time, we would like to keep you informed with relevant content and about new developments in healthcare and patient surveys. We can keep you informed by e-mail.

HOW WE USE INFORMATION

Treating your personal data with care is important to us. Please read our privacy policy where you can find detailed information on how we protect and use personal data.

Email Address

Confirm Email Address

Full Name LEAVE THIS BLANK

Billing Address

First Name

Last Name

Address 1

Address 2

City

County

Postal Code

Country

Phone

Payment Information We Accept Visa, Mastercard, American Express, and Discover

Card Number

Expiration Date /

Security Code (CVC)

Processing...

[/not_logged_in]