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Covid-19 vaccination - supporting practices
Text from covering email explaining reason for survey and data sharing information.
*
1.
Contact details
(Required.)
Name
Email address
Phone number
*
2.
GMC number
(Required.)
*
3.
Please select the London Borough/LMC area where you are available to work (tick all that apply).
(Required.)
Barnet
Bexley
Brent
Bromley
Camden
City and Hackney
Ealing
Enfield
Greenwich
Haringey
Harrow
Hammersmith and Fulham
Hillingdon
Hounslow
Islington
Kensington and Chelsea
Lambeth
Lewisham
Merton
Newham
Redbridge
Southwark
Sutton
Tower Hamlets
Waltham Forest
Wandsworth
Westminster
Other (please specify)
*
4.
Days and times you are available for work (tick all that apply).
(Required.)
Early
Standard working hours
Late
Monday
Early
Standard working hours
Late
Tuesday
Early
Standard working hours
Late
Wednesday
Early
Standard working hours
Late
Thursday
Early
Standard working hours
Late
Friday
Early
Standard working hours
Late
Saturday
Early
Standard working hours
Late
Sunday
Early
Standard working hours
Late
*
5.
Availability over vaccination programme delivery period (tick all that apply).
(Required.)
December 2020
January 2021
February 2021
March 2021
*
6.
Please tick to confirm that you give your explicit consent for the information you have provided, including your contact details, to be shared securely on request with practices who are looking for available GPs in the areas you have indicated. You can withdraw your consent at any time by contacting
governance@lmc.org.uk
.
(Required.)
I consent
