Person with a Neurological Condition Membership Form

Before completing this form we advise that you have been in touch with us by phone on 01244 678619 or e-mail [email protected] to make sure we are able to help you with any questions you may have and to give you information about our services.

We support people with a range of degenerative neurological conditions our list can be found at: https://www.neurotherapycentre.org/conditions-we-support

Personal Details
Services
Emergency/Carer Contact
Health details
Consent

Member Updates

The Neuro Therapy Centre issues regular newsletters to its members over e-mail which cover therapies taking place at the Centre and updates to the Centre’s services. We may also use the telephone numbers you have provided to contact you in an emergency and to support you. In line with our privacy policy you may unsubscribe and change how you prefer us to contact you at any time by contacting [email protected]

We will always store your personal details securely. We’ll use them to provide the service that you have requested, and communicate with you in the way(s) that you have agreed to. Your data may also be used for analysis purposes, to help us provide the best service possible and anonymously to support our fundraising and reporting to health authorities. For full details see our Privacy Policy https://www.neurotherapycentre.org/privacy-policy