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How can we help?
Contact details
In order that we can deal with your request as quickly as possible, please take a few moments to complete all of the following information.
*
Indicates required field
Name
*
First
Last
Phone Number
*
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Patient details
Name
*
First
Last
Date of Birth
*
Medical Diagnosis
*
XP (xeroderma pigmentosum)
Other condition
Parent/guardian (if different)
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Email
*
How can we help you?
We offer a number of patient support services, please tick the box with relates to your request for assistance and we will do our best to provide support and guidance where we can, subject to funding and eligibility.
Practical and emotional support
Tick all relevant
*
I`d like someone to email or call me
I am looking for general guidance on living with XP
I am looking for guidance on clothing, equipment etc
l would like guidance on a Blue Badge parking application (UK only)
I would like guidance on a DLA/PIP application or tribunal (UK only)
I would like more information about safe, short break/holiday sites in the UK
Helpful resources
Tick any relevant
*
My child is under 12 years old and I would like to be considered for a Little Ted pack
My child is nursery or primary age and would like a Little Ted educational resource pack for their school (UK only)
I would like to request a UV protective hat for myself/my child
I would like to request a pair of UV protective gloves
I would like to request replacement visor film
If other, please give details
*
Hats and gloves
Please complete the following if requesting free UV protective hats and gloves
Hat size - head circumference
*
46-48 inch (typically <2years)
50-52 inch (typically 2 - 5 years)
54-56 inch (typically 5 years plus)
58-60 inch (typically Teen/adult)
Glove size
*
Small (infant and child)
Medium (Teen/adult)
Large (Adult)
Important notes:
While we sincerely endeavour to provide all patients with the items they need, this is 100% dependent on us having sufficient funds and time resources to do so, and so on occasion we may have to say say no to some requests. If this is the case we will respond to notify you of this.
Can you help us?
The average package we dispatch to families costs in excess of £100 per patient, and this is supported entirely by our own fundraising efforts and by small volunteer team who all have full time jobs and families too. We always welcome any support now or in the future to allow us to continue to do what we do, so please let us know if you would like to find out more.
Choose one
*
Yes please, I would like to find out how I can make a donation and/or get involved in fundraising
I would like to know if there are other ways I can get involved and help
No thank you, I can't help or donate at this time
IMPORTANT NOTES
We receive a large volume of requests for help. All requests are dealt with in order. We are a very small volunteer team. So please be patient when waiting for a response. There are times when we may not be able to meet every request due to a lack of funding, but please be reassured we do our upmost to help everyone.
We dispatch items once per week. Some items are on a waiting list so there can be delays when we have high demand.
Teddington Trust covers all costs for the items and shipping but we cannot cover your countries customs charges. These are the responsibility of the recipient. If you do not pay these costs then the package will be returned back to us. We are not able to control this.
We are unable to dispatch any items without all necessary information being provided. Please double check you have completed all fields necessary to ensure we can help you.
Future projects and services
Please let us know what we can do to support you and provide relevant services for you now and in the future?
Comment
*
Twice yearly which will keep you updated on everything we are doing and how you can benefit and get involved. We realise that some are very happy with just this, but we do know that others like more regular and personal contact. To help us plan our communications over the year ahead we would love to hear your thoughts on this and your preferences.
Comment
*
Keeping in touch
In order that we can keep you up to date with our services and changes, we would like your permission to add you to our Patient and Family Database. We will only contact you when we have have relevant information, services and projects which you can benefit from. We do share our data (contact details only) with another UK charity who provide respite camps XP Support Group but it is not shared with any other 3rd party and we comply fully with data protections laws.
Tick as appropriate
*
Yes please, add me to your database
No thank you, not now
If you would like a copy of our data protection policy this is available upon request by contacting
[email protected]
Submit
Home
What is XP?
Projects
Little Ted
Project Breakaway
About Us
SUPPORT
Supporting You
Action Advice Hub
Schools Hub
Get Involved
Gallery
News
Contact