JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Print Run Interest
Enter your details to register your interest in purchasing a printed copy of the My Chronic Health & Care Passport. (UK Standard Edition only for now). This doesn't commit you to buying one, but will help me gauge whether or not it is viable to try to organise a limited batch of copies.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
I am a...
Person with a chronic illness
Person with a long-term disability
Parent/guardian/carer of someone who would use the passport
A member of a health/care organisation
Other:
Clear selection
Name
*
Your answer
Email (if you wish to be kept updated on the availability of printed copies)
Your answer
Which of these would you be most interested in purchasing?
*
Standard 18 page booklet (4 'My Conditions' sections)
Standard booklet + 1 extra 'My Conditions' sheet? (8 'My Conditions' sections)
Standard Booklet + Extra 'My Conditions' sheet + Extra 'Appointment Notes/Questions' Sheet
Other:
Required
Knowing that any profit would go to charity or to help send some printed copies to hospitals, what would you be willing to pay for a professionally printed A5 copy of the Chronic Health & Care Passport? (Including P&P)
Your answer
Is there anything else you'd like to see us offer printed versions of, such as the Large Print editions or the posters for doctors surgeries?
Your answer
Would you be interested in things like fridge magnets, luggage tags, or glovebox/scooter stickers, alerting people to check for your Chronic Health & Care Passport in an emergency?
Yes
No
Maybe
Clear selection
Thank you for answering!
If you have left your email address then we'll be in touch if a print run becomes viable.
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
