This additional information will help us to ensure we try to speak to representative sample of the patients that are registered at the practice: □ □ Are you? Male Female Which of the following ethnic backgrounds would you most closely identify with? White: □ □ British Group Irish Mixed: □ □ White & Black Carribean White & Black White & Asian Asian or Asian British: □ □ □ Indian Pakistani Bangladeshi Black or Black British: □ □ Carribean African Chinese or other ethnic: □ □ Chinese Any other Thank you. The information you supply will be used lawfully, in accordance with the Data Protection Act 1998.
This additional information will help us to ensure we try to speak to representative sample of the patients that are registered at the practice: Are you? Male □ Female □ Which of the following ethnic backgrounds would you most closely identify with? White: British Group □ Irish □ Mixed: White & Black Carribean □ White & Black White & Asian □ Asian or Asian British: Indian □ Pakistani □ Bangladeshi □ Black or Black British: Carribean □ African □ Chinese or other ethnic: Chinese □ Any other □ Thank you. The information you supply will be used lawfully, in accordance with the Data Protection Act 1998.
Draft_sign-up_leaflet_(3).docx