Membership Application and Renewal Instructions

If you would prefer to print and mail your membership form please select from the following:

 

Confidentiality

All information, including health information, supplied on membership forms is confidential and voluntary and will not be disclosed to others outside the APF’s Office Bearers and their appointed task bearers, without your permission.   The information below will allow us to conduct statistical surveys and provide our services to you.  Please see our Privacy Policy on the lower task bar of the website.

Patient / Carer / Partner Applicantions

All applicants must be over the age of 18 years and can be:

  • the patient themselves
  • a carer, partner or family member of an adult patient (we advise you seek permission from the patient first before disclosing their personal details)
  • a carer, parent or family member of an infant/child/adolescent under the age of 18 years

Conditions

ORIGINAL CONDITION:   Please select only ONE from the drop down list.  This is the primary cause of your pituitary problem   ie. Acromegaly / Pituitary tumour: Non-functioning / Brain injury / Congenital.

CURRENT CONDITIONS:  You can select up to 4 current conditions.  These describe where you are at the moment.

  • If your original condition has been resolved (in remission or successful treatment 
    Please select N/A to Current Condition 1
  • If your original condition has not been resolved and you have no additional conditions
    In Current Condition 1 please select the same condition as Original Condition

  • If your original condition has been resolved, and you now find you have acquired other conditions since treatment (such as Panhypopituitarism or DI 
    Please select in Current Conditions 1, 2, 3 & 4 conditions you may have acquired or have currently – choosing 1 as most prominent (for example Panhyopituitarism)
  • If your original condition has not been resolved, and you now find you have acquired other conditions since treatment (such as Panhypopituitarism or DI) 
    Please select in Current Condition 1 the same condition as Original Condition, then in 2, 3 & 4 select other conditions you may have acquired or have currently – choosing 2 as most prominent (for example Panhyopituitarism)

Treatments

SURGERY:               Please tick if you have had surgery.   4 selections will appear – allowing  you to provide details of multiple or different surgeries.

RADIOTHERAPY:   Similar to surgery

Patient Contact Register

Some members have expressed the desire to be able to contact fellow members. The Phone and Email Patient Contact Register is designed to enable direct contact between patient or family / carer members with their permission. You might like to be part of this Register.

If so, when you tick “yes” a consent form will pop up for you to complete online.  By clicking the “I CONSENT” button on this form, you are confirming that you understand and agree to the terms of use mentioned on the form. You may also print the form before you submit by using the PRINT button.