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CONTINENCE SERVICE REFERRAL FORM Please complete this form in full as incomplete forms will be returned which will delay the referral PATIENTS DETAILS Title: Forename(s): Surname’M NHS Number: D.O.B:
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Any form of mixed background refers to individuals who come from different cultural or ethnic backgrounds.
Anyone who identifies as having a mixed background or is required to disclose their cultural or ethnic background may need to fill out any form related to mixed background.
To fill out any form related to mixed background, individuals typically provide information about their different cultural or ethnic backgrounds.
The purpose of any form related to mixed background is to track and acknowledge the diverse backgrounds of individuals.
Information that must be reported on any form related to mixed background may include details about specific cultural or ethnic backgrounds that an individual identifies with.
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