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Expressions of Interest
GSF Domiciliary Care Expression of Interest Form
How did you hear about GSF?
Word of mouth
Recommendation
Care Home
GP Practice
Hospital
CCG
Mail shot
Email
Website
Other
Contact Name:
*
Organisation Type (i.e. Dom Care Agency, Commissioner etc)
*
Organisation Name:
*
Organisation Address:
*
Ownership of Organisation?
*
Privately Owned
Charity
Council
Part of a group/corporate
If group/corporate, please state name & how many organisations
Telephone No:
*
Mobile No.
E-mail:
*
How many Domiciliary Care workers do you wish to train?
*
How many branches do you have in the UK?
*
How many Domiciliary Care workers does your organisation employ in total?
*
Facilitator/PCT Name:
Suggested Location:
*
Additional Comments:
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