Young person with a single ventricle heart, under the age of 18 years .

Young Person with a single ventricle heart, ages 11 -18 – 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*
Your date of birth*
Date Format: 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*
Do you know which hospital you are treated at?
Do you know who your consultant is?
Do you know what surgery you have had or what stage of surgery you are at?
Are your parents also members of LHM?
- Yes
- No
If Yes, what are their names?
Would you like to be put in touch with someone who has had a similar experience?
- Yes
- No
Any additional information

Become a member - (bear in mind guys that if you're under 18 years your parents/carers need to be members too)

Young Person with a single ventricle heart, ages 11 -18 – Registration form

Get in touch with Little Hearts Matter