Your name
Your email address*
Your phone number
Please tell us why you have contacted the Helpline (up to 50 characters)
Is there anything else you would like to add that will enable our nurses to support you?
Please tell us your age (it is helpful to the nurses when handling your enquiry)
Please Select
12 Or Younger
13-17
18-34
35-54
55-69
70 Or Older
Ethnicity - melanoma is not isolated to fair skin and this information is useful for the charity to ensure we are providing a service for everyone)
Please Select
White
Black
Black British
African
Caribbean
Asian
Asian British
Mixed Ethnic Groups
Other
Prefer not to say
Region - we ask this, both for the charities purposes as well as for the nurse dealing with your enquiry. Knowing the region may help offer locational signposting if required.
Please Select
East Midlands
East of England
London
North East
North West
Northern Ireland
Not Known
Scotland
South East
South West
Wales
West Midlands
Yorks & Humber
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