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* 1. Full Name

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* 2. Email address

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* 3. Have you already committed to another Elective in the Trust?

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* 4. If you have already made arrangements for an Elective within a GP Practice please let us know the practice and dates/length arranged

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* 5. What is your preferred placement length?

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* 6. What is your preferred area as a base for a Primary Care Elective?

  First Second Third
Belfast
South East
Southern
Northern (North of North)
Northern (South of North)
North West
South West

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* 7. What are your preferred dates between July and August 2021?

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* 8. Any other comments

0 of 8 answered
 

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