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Email address
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First name
Last name
City/town
Country
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Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (the Democratic Republic of the)
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (the Democratic People's Republic of)
Korea (the Republic of)
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (the Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela (Bolivarian Republic of)
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other fields
Other fields
Other fields
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Profession
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Allied Healthcare Professional
Doctor
Healthcare Scientist
Midwife
Nurse
Pharmacy
Psychology
Other
None
Where 'other' profession selected - please specify.
Specialty - please select from drop down list below.
Not selected
Acute internal medicine
Allergy
Anaesthetics
Audio vestibular medicine
Aviation and space medicine
Cardio-thoracic surgery
Cardiology
Chemical pathology
Child and adolescent psychiatry
Clinical genetics
Clinical neurophysiology
Clinical oncology
Clinical pharmacology and therapeutics
Clinical radiology
Community sexual and reproductive health
Dermatology
Diagnostic neuropathology
Emergency medicine
Endocrinology and diabetes mellitus
Forensic histopathology
Forensic psychiatry
Gastroenterology
General (internal) medicine
General practitioner
General psychiatry
General surgery
Genitourinary medicine
Geriatric medicine
Haematology
Histopathology
Immunology
Infectious diseases
Intensive care medicine
Medical microbiology
Medical oncology
Medical opthalmology
Medical psychotherapy
Medical virology
Neurology
Neurosurgery
Nuclear medicine
Obstetrics and gynaecology
Occupational medicine
Old age psychiatry
Opthalmology
Oral and maxillofacial surgery
Otolaryngology
Pharmaceutical medicine
Plastic surgery
Psychiatry of learning disability
Public health medicine
Rehabilitation medicine
Renal medicine
Respiratory medicine
Rheumatology
Sport and exercise medicine
Trauma and orthopaedic surgery
Tropical medicine
Urology
Vascular surgery
Organisation type
Please select from the dropdown list.
GP Practice
ICS/ STP
Independent Hospital
NHS Acute and Community Trust
NHS Acute and Mental Health Trust
NHS Acute Trust
NHS Ambulance Service Trust
NHS Clinical Commissioning Group
NHS Community Trust
NHS Hospital
NHS Mental Health and Community Trust
NHS Mental Health Trust
Pharmacy - community
Pharmacy - online
Primary Care Network
Other
N/A
Where other organisation type selected, please specify.
Region
Please select from the dropdown list.
East Midlands
East of England
National
Other
Where 'other' region selected, please specify.
Trust employer
Please select from the dropdown list.
Bedfordshire Hospitals NHS Foundation Trust
Cambridge University Hospitals NHS Foundation Trust
Cambridgeshire & Peterborough NHS Foundation Trust
Cambridgeshire Community Services NHS Trust
Derbyshire Community Health Services NHS Foundation Trust
Derbyshire Healthcare NHS Foundation Trust
East and North Hertfordshire NHS Trust
East Midlands Ambulance Service NHS Trust
East of England Ambulance Service NHS Trust
East Suffolk and North Essex NHS Foundation Trust
Essex Partnership University NHS Foundation Trust
Hertfordshire Community NHS Trust
James Paget University Hospitals NHS Foundation Trust
Kettering General Hospital NHS Foundation Trust
Leicestershire Partnership NHS Trust
Lincolnshire Community Health Services NHS Trust
Lincolnshire Partnership NHS Foundation Trust
Norfolk and Norwich University Hospitals NHS Foundation Trust
Norfolk and Suffolk NHS Foundation Trust
Norfolk Community Health and Care NHS Trust
North West Anglia NHS Foundation Trust
Northampton General Hospital NHS Trust
Northamptonshire Healthcare NHS Foundation Trust
Nottingham University Hospitals NHS Trust
Nottinghamshire Healthcare NHS Foundation Trust
Royal Papworth Hospital NHS Foundation Trust
Sherwood Forest Hospitals NHS Foundation Trust
The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust
United Lincolnshire Hospitals NHS Trust
University Hospital of Derby and Burton NHS Foundation Trust
University Hospitals of Leicester NHS Trust
West Suffolk NHS Foundation Trust
Other
Where 'other' employer selected, please specify.
Required