Make a Pledge

Please complete the form below that will contain all the details of your pledge. Once you have submitted your pledge there will be a short delay before it will appear on the site.

Please note

The answers that you provide for questions 1-7 will be in the public domain.

The answers that you provide for question 8 will remain strictly private and confidential. They will only be given to the NHS member of staff who is awarded your pledge so that they can contact you.

Once the pledges have been awarded, we will also let you know the name and the contact details of the NHS staff member who has been awarded your pledge

Once again thank you for your pledge however small or large. I am sure it will be greatly appreciated by the NHS staff.

Step 1 of 2

1. Name of company*
2. Web address or social handles (if applicable)
3. Please upload a square image of your company logo (if applicable) & relevant
Accepted file types: jpg, png.
Accepted file formats: .jpg .png. (Ideally W500 x H500px) and less than 2 MB in size.
4. Please provide full details of your pledge. Please include the location if appropriate and any conditions / exclusions of the pledge*
5. Upload an image relevant to your Pledge
Accepted file types: jpg, png.
This may be a picture of a product, your establishment / premises or an event image. Whatever you feel captures your pledge. Please provide landscape images only (ideally W1200 x H800 px) and less than 2MB in size.
6. Brief details of yourself / your company if you wish (Optional)
7. Why you want to make the pledge / send a message to the NHS (Optional)