In Conjunction with the North of England

Commissioning Support Unit

REGISTRATION FORM

To register for the event, please complete this form in full and send it to forumroadshow@pharman.co.uk

Registration details
Name:	Click to enter text
Job Title:	Click to enter text
Organisation:	Click to enter text
Specialist operational area:	Click to enter text
Specialist clinical area:	Click to enter text
Email address:	Click to enter text
Mobile telephone no:	Click to enter text
Twitter address:	Click to enter text
Dietary or special requirements:	Click to enter text
Satellite Sessions – please indicate choice of 4 in order of preference
Satellite	Preference (choose from drop down list)
Respiratory Medicine – Grainne D’Ancona, Principal Pharmacist Acute Medicines, Guys & St Thomas Teaching Hospital London and Finlay Royle, Prescribing Advisor, Lambeth Clinical Commissioning Group	Choose one
Diabetes Medicines Optimisation– Ben Woodhouse, Medicines Optimisation and Prescribing Lead, NHS Bolton Clinical Commissioning Group (this satellite is organized and funded by Takeda UK Ltd)	Choose one
Anticoagulation Policy – Satinder Bhandal Consultant Anticoagulation Pharmacist , Buckinghamshire Healthcare Trust High Wycombe	Choose one
Medicines Optimisation in Care Homes – Helen Whiteside Clinical Care Homes Pharmacist & Independent Prescriber, Leeds West CCG	Choose one
Shared Decision Making - Shirley Simpson, Pharmacist Practitioner, Collingwood Health Group	Choose one
Consultation Skills – Lesley Grimes, Senior Pharmacist – Learning and Development, Centre for Pharmacy Postgraduate Education	Choose one