Join us Now

Email address*

First Name*

Last Name*

House number and street name

City/Town

County

Postcode*

Phone Number

Gender Male Female Transgender Other (you may be contacted further about this information) Prefer not to say

Age*
18 - 39
40 - 65
66 - 79
80+

Ethnicity Asian or Asian British (Pakistan) Asian or Asian British (Bangladesh) Asian or Asian British (India) Asian or Asian British (Any other background) Black or British Black (Caribbean) Black or British Black (African) Black or British Black (Any other baclground) Mixed (White and Black Caribbean) Mixed (White and Black African) Mixed (White and Asian) White (British) White (Irish) White (Any other background) Chinese Any other background Prefer not to say

Which research areas can you help with?

Please tick as many of the boxes below that relate to areas of health research you think you might like to contribute to. You can tick as many as you like.

Conditions and Illnesses (Can select multiple) Heart Cancer Diabetes Mental Health Dementia Women's Health and Maternity Respiratory, e.g. asthma, COPD Eye Health Digestive Disorders Musculoskeletal Disorders Health of your Child Public Health Health Services Research Other All