Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Contact information
LISP Study: Longitudinal Investigation of Secondary Pneumothorax
For further information or questions about the LISP study please contact
Steve Walker
steven.walker@bristol.ac.uk
INSPIRE:
inspire.resp.research@gmail.com
* Indicates required question
First Name
*
Your answer
Surname
*
Your answer
Email (this will be used as the primary way of contacting you about the study)
*
Your answer
Mobile phone number (this will be used as a secondary way of contacting you about the study but is not required)
Your answer
Stage of training
ST3
ST4
ST5
ST6
ST7
Out of programme
Other
Deanery
HE East Midlands
HE East of England
London
HE North East
HE North West
HE South West
HE Thames Valley
HE Wessex
HE West Midlands
HE Yorkshire and Humber
Scotland
Wales
Northern Ireland
Placement hospital/hospitals for September 2022 - September 2023 (please indicate when you expect to find out if this is unknown)
Your answer
I am happy to be contacted by (please check all that apply)
Email
Phone call
Text Message
Added to WhatsApp group or similar messaging service
I understand and consent to the information I have submitted being stored securely online, and used by the LISP and INSPIRE administration teams to allow them to contact me regarding my participation in this study. I understand it will not be shared with any third party. I understand that I can withdraw my consent to store and use my information at any time. (Please see the INSPIRE website
https://inspirerespiratory.co.uk/privacy/
for full details of our privacy notice and your data protection rights).
Yes
Comments or Feedback
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report