History Taking and Clinical Skills Training

History Taking and Clinical Skills Training
Name*

First NameLast Name
Email*
example@example.com Please provide your email address so we can contact you about further developments regarding the prospective training session.
My job role is...*
e.g. Pharmacist
My area of work is...*

Pre-HospitalCommunityHospitalPrimary CareOther
I would rate my level of competence in taking a patient history to be...*

1

2

3

4

5

6

7

8

9

10

1 is I really struggle, 10 is I'm great!
The best month for me would be...*

June 2024July 2024August 2024September 2024October 2024November 2024December 2024January 2025Other
Day of the week that would work best for me...*

SundayMondayTuesdayWednesdayThursdayFridaySaturday
I want to attend a session that can...*
Which area would be most the convenient for you to attend a session in:

Northeast EnglandNorthwest EnglandYorkshire and the HumberEast MidlandsWest MidlandsEast of EnglandLondonSouth EastSouth WestScotlandWalesNorthern Island
By filling in and submitting this form, I understand that I am expressing my interest in the above training with ECG and agreeing to be contacted about the course. This is not a guarantee of enrollment but an expression of interest.

Disclaimer and GDPR Statement: By submitting this form, you agree to our privacy terms. Your personal data will be used solely for the purpose of contacting you regarding this training session. We are committed to protecting your privacy and ensuring your data is handled securely. For more information, please refer to our Privacy Policy.
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