Please print, complete and return the application form.

We will then send you:

• A personalised card which you should carry at all times. Details of your next-of-kin can be put on the card, or the name and number of someone you trust.
• A medallion, which you should wear at all times.
• Two copies of the Statement of Medical Care Principles

Copy 1

Please give this to the person named on your Patients First Network card. You should ask that person to have this with them when any discussion about your best interests takes place with medical care workers in hospital.

Copy 2

Please ask your GP to put this copy with your medical notes.