Covid-19 vaccination - supporting practices

Text from covering email explaining reason for survey and data sharing information.

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* 1. Contact details

Name

Email address

Phone number

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* 2. GMC number

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* 3. Please select the London Borough/LMC area where you are available to work (tick all that apply).

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)

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* 4. Days and times you are available for work (tick all that apply).

	Early	Standard working hours	Late
Monday	Monday Early	Monday Standard working hours	Monday Late
Tuesday	Tuesday Early	Tuesday Standard working hours	Tuesday Late
Wednesday	Wednesday Early	Wednesday Standard working hours	Wednesday Late
Thursday	Thursday Early	Thursday Standard working hours	Thursday Late
Friday	Friday Early	Friday Standard working hours	Friday Late
Saturday	Saturday Early	Saturday Standard working hours	Saturday Late
Sunday	Sunday Early	Sunday Standard working hours	Sunday Late

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* 5. Availability over vaccination programme delivery period (tick all that apply).

December 2020

January 2021

February 2021

March 2021

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* 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.

I consent