Skip to main content

Patient organisation questionnaire

Our submission form will only take a few minutes to complete but responses will be lost if you navigate away from the form before clicking the 'Submit' button at the end. 

You can give us as much information as you like but please don’t give any personal details on the form that might identify you or someone else (such as full names, dates of birth, addresses). If you do include any personal details, we'll remove them before before we send your submission to committee members.

We will NOT publish your responses on this website or in the public domain. Any information you give us using this form will only be used for the appraisal of the medicine stated. We will not use it for any other purpose or share it with third parties. We collect and store all submissions within the provisions of the UK Data Protection Act 2018 and the UK General Data Protection Regulations (GDPR) 2018. Please see our Privacy Policy or contact us for more information.
Cardiff and Vale University Health Board is the data controller for any personal data submitted.
The lawful basis for processing this personal data under the UK GDPR is article 6(1)(e): processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller and 9(2)(h): the provision of health or social care.
Data will be retained in line with the Records Management Code of Practice for Health and Social Care 2022.
• For any complaints in relation to how your data has been handled, please contact
• For further information on your personal data is processed, please see our privacy notice at 

If you have any questions, or if you find it difficult to fill in the form, please contact us and we’ll try to help. You might also find our FAQs useful, see our New medicines needing your views page.