Please fill in the white boxes below to show your availability: available; may be ‘Y’= ‘?’= available; = not available. ‘N’ Appointments last up to 50 minutes. Term time: 9am 10am 11am 12pm 1pm 2pm 3pm 4pm Monday Wednesday If your timetable changes each week please give further details here: Are you in Cambridge during the next vacation? If so, please indicate the likely dates: I agree that the information above will be stored on computer for the sole use of the Health Centre staff and that anonymous data may be used for statistical and evaluation purposes. Please sign (or type name if completing electronically): Signed: Date: ………………………………………………………………… …………………………… Please continue to Part B
Please fill in the white boxes below to show your availability: ‘Y’= available; ‘?’= may be available; ‘N’ = not available. Appointments last up to 50 minutes. Term time: 9am 10am 11am 12pm 1pm 2pm 3pm 4pm Monday Wednesday If your timetable changes each week please give further details here: Are you in Cambridge during the next vacation? If so, please indicate the likely dates: I agree that the information above will be stored on computer for the sole use of the Health Centre staff and that anonymous data may be used for statistical and evaluation purposes. Please sign (or type name if completing electronically): Signed: ………………………………………………………………… Date: …………………………… Please continue to Part B
Registration%20form_2.docx