Derbyshire Focus Group interest Oral Health

Thank you for your interest in taking part in our Derbyshire Oral Health 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

Postal Code

Email Address

Phone Number

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* 2. What is your Gender?

Female

Male

Prefer not to say

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* 3. Which age group does your Child Fall into?

0-5

5-10

Over 10

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

Focus Group

1:1 Interview

Both