PALS contact form

Published/updated: 31/08/17 14:53

Please note that the contents of this form will not be encrypted upon submission. If you would prefer not to use this form to submit your information, please contact PALS

Telephone 0121 424 0808 (Monday to Friday 09:00am – 3:30pm). There is a voicemail facility outside of these times.

Name of the person making contact

Name of person contact relates to-if different

Hospital Number-if known

Relationship to Patient - if different

Patients Address

Patients Date of Birth

Contact telephone number

Alternative telephone number

Email address

What is the best time to contact you?

Reason for contacting us

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