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* 1. Surname

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* 2. First name(s)

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* 3. Pharmacy Council Registration number

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* 4. email address

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* 5. contact phone number

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* 6. Which DHB do you currently reside in?

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* 7. Are you also available to work outside your DHB of residence?

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* 8. If so, which DHB(s) are you available to work in?

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* 9. Approximately how many hours per week are you available to work?

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* 10. Most recent area of clinical practice

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