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* 1. Please tick the main option which applies to you I am

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* 2. Please select the practice you are registered with:

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* 3. What do you most value about your current practice and would like to be continued after the possible merger? Please use the space below for your comments

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* 4. What do you not like about your experience of your current practice and would like to be improved in the proposed merger? Please use the space below for your comments

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* 5. Do you have any comments or questions regarding the proposed merger, please use the space below to tell us more?

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* 6. We have a question and answer session at Horton Park Medical Practice and Parkside Medical practice on Thursday 14th March 1-2pm if you would like to attend and ask any questions in person

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