Adult with a single ventricle heart - Little Hearts Matter

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Become a member / Adult with a single ventricle heart

Adult with a single ventricle heart – Registration Form

Becoming a member of Little Hearts Matter could not be easier and is free to anyone seeking support and information because they are affected by a diagnosis of a single ventricle heart condition.

Please fill in the form below and a member of our team will be in touch.

Surname*
First name*
Address*
Address Line 1 Address Line 2 Town/City ZIP / Postal Code
Contact telephone numbers*
Email address*

If you do not have an email address, please specify NONE.
Facebook Name
Your date of birth*
DD slash MM slash YYYY
Your gender
- Female
- Male
- Other
- Would rather not say
Your diagnosis*
Please upload a copy of the first page of any clinic or hospital letter you have to confirm the diagnosis*
Max. file size: 50 MB.
Treatment centre
Consultant
Stage of surgery
Are any relatives/family also members of LHM?
- Yes
- No
Do you have a partner?
- Yes
- No
Do you have any children?
- Yes
- No
Would you like to be put in touch with someone who has had a similar experience?
- Yes
- No
Any additional information
*
- I have read and agree to the LHM Membership Terms and Conditions*
MEMBERSHIP OF THE CHARITY REQUIRES AN OPEN AND HONEST SUBMISSION OF INFORMATION ON APPLICATION AND DURING THE TERM OF THE MEMBERSHIP
Contact*
I would like to receive updates about the work of LHM, including support & information, fundraising and awareness campaigns. If so, please indicate below your preferred method of contact:
- Post
- Email
- Phone
*
- White
- Mixed
- Asian or Asian British
- Black or Black British
- Chinese
- Any other ethnic background

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Parent of a child with a single ventricle heart
Parent expecting a child with a single ventricle heart
Parent who has lost a child because of complex congenital heart disease
Grandparent, or expectant grandparent, of a child with a single ventricle heart
Adult with a single ventricle heart
Young person with a single ventricle heart, under the age of 18 years .
Extended family member
Health professional
Education professional
Social service professional
Friend of the charity

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Don’t forget to register for the benefits webinar this Saturday 22 Jan @10:30am. Pat will talk about welfare benefit entitlement, advice for disabled jobseekers, ESA, Universal Credit and PIPs.You'll need to be signed up to register: sfhearts.org.uk/members-area/#…

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The LHM office will be closed from the 23rd to the 30th December, but our members can still contact us if they need a chat.📱 0121 455 8982📧 [email protected] ❤️Or drop us a private message ... See MoreSee Less

4 weeks ago ·

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💬 Charlie is loving Christmas this year and is excited for Santa to visit!💬With Charlie’s Fontan operation likely to happen in the Spring next year we are enjoying every precious moment as a family this Christmas.❤ ... See MoreSee Less

1 month ago ·

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