Birmingham Children's status check

Tell us if anything has changed

Thank you for your help in ensuring that we continue to be able to provide the best services possible during these difficult times. You have been directed to this webpage in a letter that we sent you in order to provide information in the simplest way possible. We would be grateful if you could fill this form out completely to avoid us needing to contact you unnecessarily.

Please provide the following details to allow us to make sure we know who the patient is – we need all 3 pieces of information to make sure (hint: some of this is on the letter we sent you!):

Please enter your details

Note: Questions marked by * are mandatory

Your data will only be used for the purposes described in this form and will not be shared with any third parties.

*This is a mandatory field. Patient Number

*This is a mandatory field. Waiting List Identifier

*This is a mandatory field. Date of birth

*This is a mandatory field. Do you have parental responsibility for the patient?

Yes
No

What is your relationship with the patient?

*This is a mandatory field. Has your child developed any new symptoms or problems since going on the waiting list for their treatment/surgery/outpatient appointment?

Yes
No

If yes – Please can you describe these new symptoms or problems?

*This is a mandatory field. Have you taken your child to an Emergency Department (A&E), to your GP or another urgent care doctor because of problems related to why they are under the care of our hospitals?

Yes
No

If Yes - Please Give Detail

*This is a mandatory field. Does your child still need the treatment/surgery/procedure they are on the waiting list for?

Yes
No

If No – please let us know why the treatment/surgery/procedure is no longer needed.

*This is a mandatory field. A number of patients and families are concerned about attending hospital during the Covid-19 pandemic. Please let us know if you would be able to attend if we were able to offer an appointment date:

About you and your preferences:

In future, we would like to begin to share communication with patients and families by email. If you would be happy to be contacted by email, please provide an email address here:

About your response:

We need to share information with partner organisations to enable some treatments. This may involve providing the minimum information to another hospital nearby in order to speed up access to treatment. We may also need to share information with your GP. We will only ever communicate the minimum information in order to arrange or support necessary health care activities, or to ensure the safety of patients.

* Spam Guard: Is a stop sign red or blue?

Birmingham Children's status check

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