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Seek Support
Support Line
Antenatal Support
Social Media Support
Regional Support
Bereavement Support
Young People’s Support
Other Support
Seek Information
Antenatal Diagnosis
Diagnosis
Conditions & Treatments
The Fontan Pathway Film
Heart Animations
Lifestyle Information
Publications
Congenital Cardiac Hospitals
Stories
Family Stories
Antenatal Stories
Teen & Young Adult Stories
Stories by Adults with Half a Heart
Bereavement Stories
Grandparent Stories
Youth Zone 🧡
About the Youth Members
About Your Heart
Brave Heart Awards
Siblings
Youth Zone Downloads
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SVH Adults 💜
BECOME A MEMBER
LHM Membership Form – Adult with a single ventricle heart
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LHM Membership Form – Adult with a single ventricle heart
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LHM Membership Form – Adult with a single ventricle heart
Your Details
Your Name
(Required)
First
Last
Your Date of Birth
(Required)
Day
Month
Year
Address
(Required)
Street Address
Address Line 2
City
County / State / Region
ZIP / Postal Code
Email
(Required)
Phone Number
(Required)
Your ethnicity
White
Mixed
Asian or Asian British
Black or Black British
Chinese
Any other ethnic background
Facebook profile name
Some people use a different name on social media. Providing this will help us speed up your acceptance into our private groups.
Gender
(Required)
Male
Female
Other
Prefer not to say
Your Diagnosis
(Required)
Please give as much detail as possible here. If you are unsure about the diagnosis, what has your doctor / consultant said?
Please upload a copy of the first page of any clinic or hospital letter you have to confirm the diagnosis*
(Required)
Max. file size: 10 MB.
Treatment Centre
(Required)
Consultant
(Required)
Stage of Surgery
(Required)
Are any relatives/family also members of LHM?
Yes
No
Do you have any children?
Yes
No
Do you have a partner who also wishes to join LHM?
Yes
No
Do you have any other information to share?
Contact Preferences
Would you like to be put in touch with someone who has shared similar experiences?
(Required)
Yes
No
If you would like to receive updates about the work of LHM, including support & information, fundraising and awareness campaigns, please indicate below your methods of contact:
(Required)
Post
Email
Phone
I do not wish to be contacted
Membership Terms
(Required)
I have read and agree to the
LHM Membership Terms & Conditions
MEMBERSHIP OF THE CHARITY REQUIRES AN OPEN AND HONEST SUBMISSION OF INFORMATION ON APPLICATION AND DURING THE TERM OF THE MEMBERSHIP
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