Charco Visit Request 
Thank you very much for your interest. Whether you are local Parkinson's group, community, healthcare provider facility or any type of group who are interested in learning more about Charco, please use this form for Charco team members to come visit you to introduce Charco and the CUE1 :).

We will go through an introduction to Charco and the CUE1, show case the CUE1 so you can see how it works, and answer any questions you may have.
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What is your name? *
Please provide your email address. *
Does your group have a name? 
This is the name of the group that you would like us to visit.
Where is the group based? *
Would you like us to visit in-person or remotely i.e. through Zoom? *
Group meeting address
If you would like us to meet with your group in-person, please provide the address / region where the group usually meets.
How big is your group?
When does the group usually meet?
 *
For example, your group may meet at 11am on every last Thursday of the month.
Do you have any proposed dates for us to visit?
If yes, please provide the dates as a list in DD/MM/YY format. For example:

10/07/23, 10/08/23, 10/09/23
We would like to...
We consent to....
Other comments ..
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