Before completing this form
I have read, understood and I agree to the terms outlined in the disclaimer, including the privacy statement, and privacy statement for consultations:
(Please tick box to agree).
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| Please provide us with your preferred email address so that we can acknowledge your comments and send feedback if requested*.
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If you wish to receive a summary of the overall feedback received from the consultation,
please tick the appropriate box below so we can send you this to you.
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Yes
No
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| In giving your views, which one
of the following best describes you? |
Name of group or organisation e.g. Trust, Charity name:
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Please see the draft policy with reference to the questions below:
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Yes
No
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Yes
No
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If you have answered no to either question 2 or 3, please provide us with details:
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Yes
No
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Thank you for taking the time to provide us with your feedback. Please either submit this form electronically or by post to:
Public Health Team,
East Midlands Specialised Commissioning Group
Fosse House
6 Smith Way
Grove Park
Enderby
Leicester LE19 1SX
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