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Seek Support
Calling our 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
Youth Stories 🧡
SVH Adult Stories 💜
Bereavement Stories
Grandparent Stories
Youth Zone 🧡
About the Youth Members
About Your Heart
Brave Heart Awards
Youth Stories 🧡
Siblings
Youth Zone Downloads
Lifestyle Information
SVH Adults 💜
BECOME A MEMBER
LHM Membership Form – Young person with a single ventricle heart
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LHM Membership Form – Young person with a single ventricle heart
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LHM Membership Form – Young person with a single ventricle heart
LHM Youth Zone membership: Young Person with a single ventricle heart, ages 11 - 18
Bear in mind guys that if you're under 18 years your parents/carers need to be members too.
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
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.
Do you know which hospital you are treated at?
(Required)
Do you know who your consultant is?
(Required)
Do you know what surgery you have had or what stage of surgery you are at?
(Required)
Are your parents also members of LHM?
(Required)
Yes
No
If yes, what are their names?
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
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
Δ
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