Independent Doctors Appraisee Network - registration application

Completion of this quick survey will enable you to register with the INDEPENDENT DOCTORS APPRAISEE NETWORK. (IDAN) . This is an innovative project developed by an appraiser, Dr Paul Myers, in response to a problem whereby doctors in independent practice occasionally have problems in networking with colleagues in the same specialty. Membership of IDAN will enable independent sector doctors to be linked together so they can share clinical information in support of their annual appraisals. How this is done in practice is up to individual doctors, but may consist of local meetings, workshops, skype (remote video) discussions, or information exchanges via emails.
IDAN membership is free, and confidential. You will only be linked to other doctors if you ask us to do this.

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* 1. Firstly, what is your name?

First (given) name

Surname (family name)

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* 2. ....and for us to confirm your identity, your GMC number.?

Enter your GMC number here:

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* 3. What is your email address?

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* 4. What is your contact telephone number?

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* 5. Which of the following best describes your PRIMARY clinical specialty?

General Practitioner

Long term locum (GP)

Long term locum (hospital)

Medical administration

Other hospital specialist (specify below)

Anaesthetist

Medico-legal report provider

Plastic Surgeon

Aesthetic Doctor

Weight reduction (slimming clinic) doctor

Provide additional details here;

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* 6. If you have an ADDITIONAL SPECIALTY you can enter this here.

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* 7. My current designated body is as follows, (Enter 'none' if applicable.)

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* 8. This question is for our administration records: Tick any that apply;

I do not have a 'route to revalidation' and would like help with this.

I have had an appraisal through Doctors Appraisal Consultancy previously

I have not had an appraisal with Doctors Appraisal Consultancy but wish to apply to join IDAN

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* 9. I confirm that I wish to apply to enrol in the IDAN programme.

Please keep my records on file. I CONFIRM I WOULD NOW LIKE MY DETAILS TO BE FORWARDED TO COLLEAGUES.

Please keep my records on file but DO NOT pass on my details to other colleagues until further notice.

Additional comments (please specify):

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* 10. Thank you for applying to join IDAN . If you have any comments about the IDAN project, or the application process please enter them below. (If you wish to contact Doctors Appraisal Consultancy visit the website; www.dacuk.net) ;