LGBT Foundation - Pride in Practice Enquiry Form

LGBT Foundation - Pride in Practice Enquiry Form
Thanks for enquiring about LGBT Foundation’s Pride in Practice. Please complete this form and we will get back to you as soon as possible. Please fill in as much information as possible so we can provide you with the correct quote. However, if you are unsure about what you would like or need at this stage, the form is to declare interest and you can decide what training to purchase at a later stage. We look forward to discussing this further with you. If you have any questions, feel free to message us at pip@lgbt.foundation
Your Name*

First NameLast Name
Name of your practice*
Your job role at the practice
Opportunity Name
She/HerHe/HimThey/ThemOtherPrefer Not To Say
Pronouns - Other
Email*
example@example.com
Mobile Number
Format: 07000000000.
Landline Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityCounty

Postal Code
Training and Assessment can be delivered together or separately. For training with the team allow 1 hour. Training can be delivered in person or online via Teams.

Assessments can be carried out at any time with Practice Manager and a member of the clinical team during a short phone call or Teams chat.
In personRemote/online
Pride in Practice Training Slots
If you have any additional requirements, please provide these here.
Are there any key issues or questions that have been raised by staff since previous Pride in Practice training (or that have come up due to previous experiences with LGBT patients in your care)?
Google SearchSocial MediaRecommendationSignposted by Health Professional (GP, care worker etc.)Word of Mouth
YesNo
Hidden Todays Date

DayMonthYear
Date
Hidden Todays Date + 180 (Close Date for Salesforce)

MonthDayYear
Date
Please verify that you are human*
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