Thank you for applying to be a GP Champion.

This questionnaire will take <5 minutes to fill out and we will email you to confirm your participation in the scheme and outline what happens next.

If you have any further questions or would like a copy of our FAQs please email

Thank you,

Meg Rowlands & Anna Harrison
South West Deanery

* 1. Please enter any personal details you are happy to be contacted by

* 2. Please enter your main GP Surgery address (work address)

* 3. What stage in your career are you at currently

* 4. What is your career background and do you have any particular interests? (eg background in surgery, GPwSI etc)

* 5. Woud youu rather be a Champion to:

* 6. What level of support would you be happy to offer? (Tick as many as apply)

* 7. Do you feel you need any extra information or support to fulfil this role?

* 8. Any other questions or comments about the GP Careers Champion scheme? We will answer these by return email.

* 9. Please select to confirm your participation: