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Expressions of Interest
GSF Care Homes 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. Care Home, Commissioner etc)
*
Organisation Name:
*
Organisation Address:
*
Are you an NCF member?
*
No
Yes
Ownership of Organisation?
*
Part of a group/corporate
Council
Privately Owned
Charity
If group/corporate, please state name & how many organisations
Type of Home:
Nursing
Residential (personal care)
Dual Registered
Other (e.g. Learning Disability etc)
If other, please specify
No. of beds in the home
*
Telephone No:
*
Mobile No.
E-mail:
*
Facilitator/PCT Name:
Suggestion Location:
*
Additional Comments:
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