Derbyshire Focus Group interest Health Checks

Thank you for your interest in taking part in our Derbyshire Health Checks Research. Please complete your details below and a member of the project team will be in touch.

Everyone who takes part in a 1:1 interview or a focus group will receive a £20 love2shop voucher

The details you provide here will only be used to contact you in relation to this project and will be kept securely on our system in accordance to our privacy statement which can be found here https://uniqueimprovements.com/privacy/

If you would like any more information about the project please email team@uni.uk.net

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* 1. Contact Information

Name

Email Address

Phone Number

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* 2. So we know what GP federation you are in please provide the first part of your postcode and your GP practice name

First part of your post code

GP practice name

GP practice postcode

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* 3. Please tell us what Age group you fall into

39 or under

40-50

51-65

Over 65

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* 4. What is your Gender?

Female

Male

Prefer not to say

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* 5. Would you be interested in taking part in the Focus group or 1:1 interview

Focus Group

1:1 Interview

Both