Patient Authority Form
The Mary Slater Charity requires a completed Patient Authority form to process any individual grant application.
If you haven’t already, please complete the Individual Grant application form and then click on the links below to download the patient application forms as a word document or PDF document.
Patient Authority Form (Word doc)
Please email jabethell@maryslater.org.uk with your completed Patient Authority form or post your completed form to The Mary Slater Charity, PO BOX 8680, Burton On Trent, DE14 9QB.