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Please complete your details on the form below. The form will be sent directly to DNV, the independent assessors appointed by Macmillan. When you have filled in the form please click the submit button.
Click on the 'Submit' button once you have finished. Fields marked * must be completed
Are you aware there is a £1,000 fee for any private healthcare organisation? (NB: registered charities and Macmillan buildings are exempt.)* !
Is your line manager aware and supportive of the application?* !
Title* << select >> Mr Miss Ms Mrs Dr Professor Other
(Title other)
First name*
Last name*
Telephone*
Job title*
Organisation name*
Address 1*
Address 2
Town/City*
County
Postcode*
Type of facility:
Day services
Information centre
Info Pod
In-patient services
Other
If other please specify
Opening hours*
How long has your facility been open?* << select >> Less than 12 months 1-2 years 2-5 years 5 years or more
Email*
How did you hear about MQEM? << select >> From the Macmillan Service Development Team Through a Macmillan Development Manager Macmillan website Another website Macmillan booklet Attended an event Newspaper Magazine/journal Through a work colleague (non-Macmillan) Through a friend Other (please specify)
If other
We do not sell or swap your details with third parties. However we will need to pass your details onto the independent assessors (DNV), who will be assessing all the candidates for the Macmillan QEM.
Email mqem@macmillan.org.uk| to find out more about the Macmillan Quality Environment Mark.