Wellness services Frailty Minor injuries unit Learning disability Urgent care iuuujhy Direct payments Demographic information You do not have to provide us with this information but it will help to ensure that the panel is representative of the population of Bath and North East Somerset and help us to send you more relevant information. If you prefer not to say please leave the answer blank. Your GP Surgery Male Gender Female (please tick ) Other
Wellness services Frailty Minor injuries unit Learning disability iuuujhy Urgent care Direct payments Demographic information You do not have to provide us with this information but it will help to ensure that the panel is representative of the population of Bath and North East Somerset and help us to send you more relevant information. If you prefer not to say please leave the answer blank. Your GP Surgery Gender (please tick ) Male Female Other
Citizens-Panel-Application-Form-easy-read.docx