If you would like to get involved in Enfield Local Involvement Network (LINk) and help shape Enfield health and social care services, please fill in this form and return it to the Host support organisation for Enfield LINk: Community Investors, Resource Centre, 2 Factory Lane, London N17 9FL or email: enfieldlink@cidagroup.org.

For further information, for help to fill in the form or to get a copy in a different format, please call Lynne Lambert or Daisi Ogunro at Community Investors on 020 8885 1900. As a Registered Data Controller, Community Investors will ensure your details are confidentially kept and used only to communicate with you about Enfield LINk.

1. Your Contact Details
Title (e.g. Mr/Ms)
Full Name
Organisation (if any)
Address
Postcode Phone
Fax Email
Your age (tick box)
Under 14 years old 14-17 years 18 or over
 

2. How would you like to be contacted?

  

3. Do you have local connections with Enfield health and social care services?

(Please tick all boxes which apply)
Post
Phone
Text
Email
Other e.g. large print
 
 
Live in borough
Work or study in borough
Registered with local GP, dentist etc
Have experience of other Enfield health
or social care services
(Unpaid) carer for local resident
Other (please state)
 

4. In which kinds of health and social care services are you particularly interested?

Hospital Young people’s services
GP (General Practitioner) Older people’s services
Dentists Continuing care
Opticians Transport for users of health and social care
services
Pharmacists Cancer
District Nursing Heart disease/stroke
Sexual health Dementia
Maternity HIV/AIDS
Mental health Drug/alcohol services
Ambulance/emergency services Health promotion
Residential/nursing homes Information
Home care/personal assistant Patient and Public involvement
Physical disability Healthier living conditions (including income
and housing)
Learning disability Other (please state)
Occupational therapy/equipment
Long term conditions e.g. diabetes    
 

5. Issues and concerns - please state any issues of particular concern to you.
 
 

6. Types of involvement In what ways might you like to get involved in the Enfield LINk?
Survey once or twice a year Join working group or committee
Survey every one or two months   Other (please state)
Receiving monthly/bi-monthly mailings  
Attend occasional events    
Help find out other people’s views    
 

7. Please add any experience or involvement which you think may be relevant