Supporting Kings Liver Transplant Patients.
Liver Transplant Support Network questionnaire

The LISTEN: Supporting Liver Transplant Patient’s Network is here to try and provide support for liver transplant patients attending King’s College Hospital before and after the operation. If you would like further information on how to either receive or offer support, please complete this questionnaire. All the information you give is optional and entirely up to you. If you do not wish to answer a question, then just move on to the next one.

 
This information will not be passed on to any other parties and will only be used for the
purposes of the Liver Transplant Support Network, LISTEN.
Title Address 1
Name Address 2
Email Town
Phone City
Mobile Postcode
Gender Country
Age Ethnic Origin
 
What Language would you prefer to recieve information?
 
What is your medical Situation?
 
What is the medical condition of your liver?
 
Tick this box If you do NOT wish to recieve information and newsletter.
 
Would you like to contact the Network for support for yourself?
Yes
no
not right now
 
Which of the following would you like to have information about? (check all that apply)
Receiving a newsletter Giving support to other patients
Joining the management committee Fundraising
 
Are there any other comments or suggestions you would like to make regarding the liver transplant support you feel you or others need?
 
Thank you for taking the time to complete this.
 
 
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