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* 1. Name

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* 2. Email address

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* 3. Phone number

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* 4. How many years since you qualified as a GP

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* 5. If less than five years ago, who was your GP trainer and training practice

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* 6. Name of current practice

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* 7. Borough of practice

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* 8. How do you think that having a mentor will be useful to you?

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