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Martin House Sign Up Information

Last Updated:

3/16/2020

Site Encrypted:

Yes

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Email Verified:

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Data Held

Email Address

Date of Birth

Password

Your Name

First Name, Last Name

Your Address

Home Address, State, Postcode

Phone Number

Phone

Post-Registration Data

We are still gathering data about this website

Validation

This site did not show evidence of storing passwords in plaintext.

This site does allow secured connections (https)

This site did show a clear way to unsubscribe from their emails

This site does verify your email address.

Membership Emails

Below is a sample of the emails you can expect to receive when signed up to Martin House.

Customer account confirmation...

Welcome to CG Habitats!

You''ve activated your customer account. Next time you shop with us, log in for faster checkout.

Visit our store

.emailview

Raw Data Registration Structure Registration Form Text

Registration

First name

Last name

Title

Password

Phone

Home address

State

Postcode

Date of birth

Gender

Help for familiesInformation for familiesCoronavirus/Covid-19 Update Martin HouseOur Care TeamWhitby LodgePlanning Your StayComing to Martin HouseAntenatal and Neonatal SupportSupport GroupsBereavement Support Care Referral FormInformation for ProfessionalsAntenatal and Neonatal SupportResearchAnnual Professional SurveyEducation and Training for ProfessionalsEducation at Martin

Routine

Urgent

Symptom Control

End Of Life

Day

Year 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966

Male

Is this child known to another hospice? (If yes, please state which hospice)

Yes

Step 3 - Carer's Details Carer 1 Parental Responsibility?

Yes

Interpreter Required?

Yes

Carer 2 Parental Responsibility?

Yes

Interpreter Required?

Yes

Male

Day

Male

Day

Male

Day

Male

Day

Male

Day

Male

Day

Step 8 - Final Information Consent Have the child�s parents (or those with parental responsibility) consented to the referral?

Yes

No Step 8 - You must have concent. Has the young person consented to the referral? (if applicable)

Yes

Data Name	Data Type	Options
First name	Text Box
Last name	Text Box
Title	Text Box
Password	Text Box
Email	Text Box
Phone	Text Box
Home address	Text Box
State	Text Box
Postcode	Text Box
Date of birth	Text Box
Gender	Text Box
	option	Help for familiesInformation for familiesCoronavirus/Covid-19 Update Martin HouseOur Care TeamWhitby LodgePlanning Your StayComing to Martin HouseAntenatal and Neonatal SupportSupport GroupsBereavement Support Care Referral FormInformation for ProfessionalsAntenatal and Neonatal SupportResearchAnnual Professional SurveyEducation and Training for ProfessionalsEducation at Martin
	option	Routine
	option	Urgent
	option	Symptom Control
	option	End Of Life
	button
	dropdown	Day
	dropdown	Day
	dropdown	Day
	option	Year 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966
	option	Male
	option	Is this child known to another hospice? (If yes, please state which hospice)
	option	Yes
	button
	button
	option	Step 3 - Carer's Details Carer 1 Parental Responsibility?
	option	Yes
	option	Interpreter Required?
	option	Yes
	option	Carer 2 Parental Responsibility?
	option	Yes
	option	Interpreter Required?
	option	Yes
	button
	button
	option
	option	Male
	dropdown	Day
	dropdown	Day
	dropdown	Day
	option
	option	Male
	dropdown	Day
	dropdown	Day
	dropdown	Day
	option
	option	Male
	dropdown	Day
	dropdown	Day
	dropdown	Day
	option
	option	Male
	dropdown	Day
	dropdown	Day
	dropdown	Day
	option
	option	Male
	dropdown	Day
	dropdown	Day
	dropdown	Day
	option
	option	Male
	dropdown	Day
	dropdown	Day
	dropdown	Day
	button
	button
	button
	button
	button
	button
	button
	button
	option	Step 8 - Final Information Consent Have the child�s parents (or those with parental responsibility) consented to the referral?
	option	Yes
	option	No Step 8 - You must have concent. Has the young person consented to the referral? (if applicable)
	option	Yes
	button