Indicates required field

About Me Awareness Card Application

Healthwatch Warrington, in collaboration with the Patient Experience and Inclusion Team at Warrington & Halton Hospital NHS Trust, is excited to introduce the About Me Awareness Card. This card is designed to inform healthcare professionals that patients may have additional needs or require extra support to enhance their experience when attending the hospital.

We are currently offering 1,000 cards to patients who may need extra support to enhance their medical appointments. By applying for a card during this six-month pilot program, you acknowledge that the card is intended to help staff at Warrington Hospital understand any extra support you may need for your appointment to run smoothly; however, its usage does not guarantee fulfilment of these adjustments.

Additionally, you agree to provide regular feedback to Healthwatch Warrington about your experiences using the card and to share your suggestions for how the card can be improved. 


Your Details

Name
Title
Address

Your requirements

Which of these do you identify as the primary source of your triggers?

Reasonable Adjustments

Reasonable Adjustments

As part of your About Me Card, you're invited to share up to three reasonable adjustments that would help support your care.

These adjustments will be securely submitted to the team at Warrington Hospital and added to your medical record. This means that even if you don’t have your card with you, the hospital staff will still be aware of your needs and will be able to assist you appropriately.

What could be a reasonable adjustment?

Read More                    

How would you like Healthwatch Warrington to record and feedback your experiences of the card?
Terms & Conditions

Terms and Conditions

The About Me card is a supportive communication tool designed to help professionals understand and respond to patient triggers that may arise during appointments. By reducing the likelihood of distress and missed appointments, it aims to promote smoother, more compassionate, and patient-centred care.

Please read the following Terms and Conditions carefully before signing up for the pilot scheme.


1. Purpose of the About Me Card

The About Me card allows patients to disclose, in a concise and non-verbal format, factors that may trigger a “fight, flight, or freeze” response during medical or therapeutic appointments. These triggers may relate to:

  • Trauma
  • Sexual assault
  • Personality disorders
  • Neurodiversity
  • Anxiety
  • Other lived experiences that may impact the patient’s emotional regulation

The card is intended to:

  • Improve communication between patients and professionals
  • Help staff make reasonable adjustments to support the patient’s wellbeing
  • Reduce stress and anxiety during appointments
  • Enhance overall appointment experiences

2. Use of the Card

  • The About Me card is for the sole use of the patient whose name is on the card.
  • Reasonable adjustments will only be considered for the named patient. Individuals accompanying the patient will not be entitled to adjustments based on their own About Me card.

3. Limitations

  • Possession of an About Me card does not guarantee that all patient preferences will be met.
  • Clinicians and staff will use the card as a tool to initiate dialogue and will make every effort to accommodate the patient’s needs, within the limits of clinical and operational constraints.

4. Data Sharing and Confidentiality

By participating in the About Me card pilot, you consent to:

  • A copy of your completed application being shared with relevant staff at the hospital or healthcare provider involved in your care.
  • Information from the card being added to your patient file for the purpose of providing appropriate support.

All data will be managed in accordance with applicable privacy regulations and used solely for the purpose of delivering patient-centred care.


5. Feedback and Evaluation

  • By joining the pilot, you agree to be contacted by Healthwatch Warrington during the pilot period.
  • You agree to provide feedback on your experience of using the card and may be invited to suggest improvements.
  • Your feedback will be vital in assessing the effectiveness of the card and determining whether the pilot should be expanded or continued beyond the initial trial.

6. Pilot Duration

  • The pilot will run from June 2025 to December 2025.
  • Participation and feedback during this period are essential to evaluating the impact of the card.

7. Agreement

By signing below, you confirm that you have read, understood, and agree to the terms and conditions of the About Me card pilot.


Signed: _____________________________________

Name (Print): ________________________________

Date: _______________________________________Terms and Conditions

The About Me card is a supportive communication tool designed to help professionals understand and respond to patient triggers that may arise during appointments. By reducing the likelihood of distress and missed appointments, it aims to promote smoother, more compassionate, and patient-centred care.

Please read the following Terms and Conditions carefully before signing up for the pilot scheme.


1. Purpose of the About Me Card

The About Me card allows patients to disclose, in a concise and non-verbal format, factors that may trigger a “fight, flight, or freeze” response during medical or therapeutic appointments. These triggers may relate to:

  • Trauma
  • Sexual assault
  • Personality disorders
  • Neurodiversity
  • Anxiety
  • Other lived experiences that may impact the patient’s emotional regulation

The card is intended to:

  • Improve communication between patients and professionals
  • Help staff make reasonable adjustments to support the patient’s wellbeing
  • Reduce stress and anxiety during appointments
  • Enhance overall appointment experiences

2. Use of the Card

  • The About Me card is for the sole use of the patient whose name is on the card.
  • Reasonable adjustments will only be considered for the named patient. Individuals accompanying the patient will not be entitled to adjustments based on their own About Me card.

3. Limitations

  • Possession of an About Me card does not guarantee that all patient preferences will be met.
  • Clinicians and staff will use the card as a tool to initiate dialogue and will make every effort to accommodate the patient’s needs, within the limits of clinical and operational constraints.

4. Data Sharing and Confidentiality

By participating in the About Me card pilot, you consent to:

  • A copy of your completed application being shared with relevant staff at the hospital or healthcare provider involved in your care.
  • Information from the card being added to your patient file for the purpose of providing appropriate support.

All data will be managed in accordance with applicable privacy regulations and used solely for the purpose of delivering patient-centred care.


5. Feedback and Evaluation

  • By joining the pilot, you agree to be contacted by Healthwatch Warrington during the pilot period.
  • You agree to provide feedback on your experience of using the card and may be invited to suggest improvements.
  • Your feedback will be vital in assessing the effectiveness of the card and determining whether the pilot should be expanded or continued beyond the initial trial.

6. Pilot Duration

  • The pilot will run from June 2025 to December 2025.
  • Participation and feedback during this period are essential to evaluating the impact of the card.

7. Agreement

By signing below, you confirm that you have read, understood, and agree to the terms and conditions of the About Me card pilot.



Sign above
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.