January TARGET – Non-medical Management of long term Conditions – North & East

Name *

Email *

Role * Select ... GP Nurse HCA Pharmacist Other - AHP Other - Non-clinical Other

Practice * Select ... Askern Medical Practice ASA Medical Group Barnburgh Surgery Conisbrough Group Practice Conisbrough Medical Practice Denaby Medical Practice Don Valley Healthcare Dunsville Medical Centre Field Road Surgery Hatfield Health Centre Mexborough Health Centre Northfield Surgery Park View Surgery Petersgate Medical Centre Primary Care Doncaster Scawsby Health Centre St John's Group Practice St Vincent Medical Centre The Burns Practice The Edlington Practice The Flying Scotsman Health Centre The Great North Medical Group The Kingthorne Group Practice The Lakeside Practice The Mayflower Medical Practice The Medical Centre The Mount Group Practice The Nayar Practice The New Surgery The Oakwood Surgery The Ransome Practice The Regent Square Group Practice The Rossington Practice The Scott Practice Thorne Moor Medical Practice Tickhill and Colliery Medical Practice West End Clinic White House Farm Medical Centre Other

I consent to my submitted data being collected and stored as outlined by the site .