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Migraine in Primary Care Advisors

MIPCA

If you are interested in joining MIPCA please fill in the form below. We will send you the members’ information pack and information on future activities. *Required field.

About You

Title:
First Name:*
Surname:*
Address:*
Affiliation:
email:*
Telephone:*

Professional group

Please tick the area that best describes your area of expertise

GP:
Nurse:
Pharmacist:
Physical Therapist:
Type of Physical Therapist:       

Complementary Therapist:
Type of Complementary Therapist:       

Other:
Please describe the medical service you offer:

MIPCA Projects

We are in the process of putting together various projects relating to several special interest groups. Please tick the boxes below if you are interested in belonging to one or more of these groups.

Education:
Research:
Running a headache clinic:
If so, please specify the type of clinic (e.g. PCT):

Request for feedback

Please use the space below for any further information you wish to supply, e.g. your feedback on MIPCA and ideas for future research and educational initiatives:

By submitting this form you agree to the information above being held on the MIPCA members’ database. This information will not be circulated to anyone outside MIPCA without the member’s permission.

Now please use the button below to send your information to MIPCA: