Heart Link - Supporting children with congenital heart disorders

Heart Link offers free membership to any family who have a child with congenital heart disorder, or a child that has been on E.C.M.O. ( Extra Corporeal Membrane Oxygenation.)

Membership is not offered to just the child with the heart disorder; mum, dad, brothers and sisters are included too. Membership offers support, advice, contact with other parents and a listening ear 24 hours a day, 7 days a week.

To become a member of the Heart Link family please complete and submit the form below and our members secretary will contact you by post to confirm your membership.

Fields marked with a * are required

Name of Patient:*

Date of Birth (dd/mm/yy):*

Name of Parent or Guardian:*

Address Line 1:*

Address Line 2:

Town:*

County:

Postcode:*

Telephone:

e-Mail:*

Condition:

Additional Comments: