Community health lead contact form

We know a form isn't the warmest, but it helps to ensure that our community health lead can help you the best. Only they have access to this form. You can also remain anonymous if you choose to be.

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(Optional) Full name (can be a pseudonym if you want to stay anonymous)

Please indicate if you are using a fictional name.

What would you like to share? *
Have you already spoken to someone about this?
Would you like to get in touch with Joske or Jo, leave your email and/or phone number (which you prefer).
Your email can be an anonymous email address.
She will reach out to you and you can share your matters with her, including discussing the next steps. It is also perfectly fine if you just want to raise awareness by sending this matter via this form only.
How urgent is this concern? *
Not urgent at all
I would like a response within 2-3 days
(Optional) Possible to elaborate here why it is urgent
Anything else you want to share?
Submit
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