SCC-AFTER Registration Questionnaire V1

Page 1

Name of person completing this form

Job role of person completing the form

NHS Trust/Health Board/Hospital name

Date of completion

Dates need to be in the format 'DD/MM/YYYY', for example 27/03/1980.

(dd/mm/yyyy)

Please indicate below if your NHS Trust/ Health Board are interested in being a site for the SCC-AFTER Study

No, we are not interested. (You do not need to complete the other parts of this questionnaire, but please click next to submit this part)

Yes, we are interested. (Complete all parts of this questionnaire so we can assess the suitability of your site. We will let you know the decision regarding progressing with set up at your site.)