Please note this form is only to apply to volunteer with us, completing it does not guarantee we will ask you to volunteer. 

We do not get much notice for these clinics so would not expect you to be available for any of them - by completing this form we will only be adding you to the mailing list which then asks if you are available when we start planning them.

You can ask us to remove you from this list at anytime by emailing mountpleasantcontact@nhs.net

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* 1. First Name

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* 2. Last Name

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* 3. Date of Birth

Date

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* 4. Email address

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* 5. Please confirm email address

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* 6. Contact number (will only be used for any same day queries)

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* 7. What GP Practice are you registered with (if not in Exeter, please also give the address)

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* 8. Have you previously volunteered for Mount Pleasant Health Centre

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* 9. Please tick the volunteer posts you would be interested in helping with

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* 10. If you have not yet been vaccinated we may be able to offer you the vaccine when you volunteer with us. 

Have you had your covid vaccination (first dose)?

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* 11. Are there any considerations we would need to make for you if you were to volunteer with us?

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* 12. As we cannot guarantee delivery dates we cannot provide dates far in advance. We will email out as soon as we begin planning any clinics and confirm with you as soon as possible.

Completing this form does not mean we will have you volunteer, it just means we will add you to our mailing list.

Please tick the box to confirm you're consent to receiving emails from Mount Pleasant Health Centre.

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* 13. Would you be interested in joining the Friends of Mount Pleasant Health Centre charity emailing list and receive information about our patient participation group?

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* 14. Any other comments/questions?

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