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Part A: To be completed by trainee Trainee Name___ MaleFemaleGP:Assistant GP: MCRN/NMBI___ GP Trainee Reg Nurse:Home Address:Practice AddressPractice Tel No:___ Mobile Tel:___Email Address: ___ I consent to use of email for administration and communication of CervicalCheck information Can you be contacted via text message? Yes No Do you have a specific learning disability that may affect your studies: I confirm that I wish to register for the
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