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Patient Organisation

We consider a Patient Organisation to be any group of individuals who have come together to highlight the needs of heart patients and their carers. Organisations must be patient-led with leadership and membership predominantly comprised of those living with a cardiovascular condition, carers or patient advocates.

Organisation Details

Name of Patient Organisation: *

Short Description of Organisation (Mission & Aims): *

Address *

Country *

Other Country *

Organisation Website (if any)

Organisation Logo *
(GIF, PNG, JPG/JPEG, Max file size: 5mb)

Please indicate yes or no:

Is your organisation registered / established as a patient organisation? *

Is your organisation managed by patients or patient advocates (with patients / advocates on your Board)? *

Is your organisation’s membership predominantly comprised of patients? *

Your organisation has a patient centric mission? *

Please select which best describes your organisation *
Not for profitFor profit (commercial)Social enterprise (primary objective is not for profit, but is making a contribution to society)

Contact Details

Primary Contact Name *

Primary Contact Email Address *

Primary Contact Telephone Number