Christmas gift request form

Contact name (required)

Email address (required)

Contact number or extension (required)

Hospital site (required)

ListerNew QEIIHertford County Hospital Mount Vernon Cancer Centre

Which ward/department are you requesting the gifts for? (required)

How many individual gifts do you require for your ward/department? (please be as exact as possible) (required)

Please describe what kind of gifts you would like for your patients? (please give examples) (required)

When would you like the gifts to be presented to your patients? (required)

Please state the staff members name who will be presenting the gifts to your patients? (required)

Do you have any local companies who are currently supporting your team who may be happy to donate gifts? (please let us know anyone that we can contact)