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Supporting our doctors triage

This form is optional. It is designed to help us support you in the most appropriate way. All Information provided will be in strictest confidence and will not be linked in any way to your membership record.

 
Role (fill in where appropriate):
Trainee
Specialty doctor i.e. SAS, Trust, etc.
Consultant
Which of the following areas do you work in? (Select all that apply)
Which of the following areas do you work in? (Select all that apply)



 
Have you been accused of
Have you been accused of




 
Clinical Director involved?
Clinical Director involved?

Supportive?
Supportive?

 
Medical Director involved?
Medical Director involved?

Supportive?
Supportive?

 
Are you on supervised practice?
Are you on supervised practice?

Have you been suspended?
Have you been suspended?

Have you been referred to the GMC?
Have you been referred to the GMC?

Are other bodies involved e.g. NCAS?
Are other bodies involved e.g. NCAS?