Petition in Support of City Hospital

The following is the text of the petition opposing the loss of emergency Inpatient Surgical and Paediatric beds at City Hospital. A printable version is available here:

http://docs.google.com/View?docid=dr2jf65_4dd92wm

This can be printed out and sent to the address at the bottom of this post, or alternatively copy and paste into Word, fill in and e-mail to supportcityhospital@googlemail.com (If you would prefer a version in Word e-mailed to you as an attached file, please request it via the same e-mail address).

The petition can also be signed online using the following link: http://www.ipetitions.com/petition/supportcityhospital/

Whichever method you decide to sign this petition by, please ensure you only sign it once.

Petition in Support of City Hospital

I oppose moving beds for Emergency Surgical Patients and Emergency Trauma Patients from City Hospital to Sandwell Hospital.


I support a 24 hour Surgical Assessment Unit at City Hospital as proposed by the surgeons and A&E doctors at City Hospital.


I oppose moving Children’s beds from City Hospital to Sandwell Hospital.


I support a Children’s Assessment Unit that remains open 24 hours a day, at City Hospital.


Name

Home Address

Contact Number

Email Address

Signature


I AM / AM NOT employed by Sandwell and West Birmingham NHS Trust (Delete as appropriate)


If you are employed by the Trust which Department do you work in?

I wish to be enrolled as a member of The City Hospital Supporters Group. YES /NO (Delete as necessary)


Membership subscription: Medical Staff £5
Non-medical Staff £1
General Public Free

NO PERSONAL DETAILS ON THIS FORM WILL BE SHARED WITH THE TRUST.

(NB: If you are signing our online petition, please ensure you tick the box entitled "Display my name as anonymous on the signatures list" if you do NOT want your name to be publicly associated with the petition)

PLEASE PUT THIS FORM IN AN ENVELOPE ADDRESSED TO:

CITY HOSPITAL SUPPORTERS GROUP
POSTGRADUATE CENTRE
CITY HOSPITAL
DUDLEY ROAD
BIRMINGHAM
B18 7QH