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NCL Connect - Practice Expression of Interest
Registration for use of Locum Staff Pool in NCL
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* Indicates required question
NCL
Practice Name
*
Your answer
Which Area is your Practice Located In
*
Barnet
Camden
Enfield
Haringey
Islington
Other:
Practice Address and Postcode
*
Your answer
Practice Telephone Number/Please give Bypass for ease of Comms or Mobile of Contact
*
Your answer
Name of the Contract Holder/Partner who will sign the Subscription Letter
*
Your answer
Email Address of Contract Holder/Partner who will sign the Subscription Letter
*
Your answer
Please Indicate the Locum Services you would find most useful
*
GPs
Nurses
ANPs
ECPs
PA's
Admin Staff
Vaccinators (Non Clinical)
Pharmacists
Other:
Required
Name of Practice Contact
*
Your answer
Email Address of Practice Contact
*
Your answer
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