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HOME VI Booking form

The next consensus meeting will be Wednesday 11th April 2018, 09:00-12:00 (satellite to the ISAD 2018 in Utrecht, The Netherlands). The focus will be on identifying valid and feasible outcome measurement instruments for atopic eczema in routine clinical practice.
Full Name

First name

Last name

Please add both your first name and last name (surname/family name).
Please select your title
Please confirm your name as you wish it to appear on your name badge

Some people have a shortened form of their name which they prefer others use (e.g. Tom for Thomas).
Please provide your email address
Please confirm the name of the institute/company/organisation you are affiliated with (if no affiliation, please state "none")
Please select your sector:

Please select the sector which most closely represents your field of work or status.
If other, please give details:

If none of the drop-down options represents your field of work or status, please give details.
Mobile phone number
Do you have any dietary requirements
YesNo

If you are a vegetarian, vegan, have celiac disease, food allergies or other conditions which restrict your diet, please select 'yes'
If yes, please provide us with details.

Add as much detail about your dietary requirements as you think is needed.
Do you have any other special requirements?
YesNo

For example, do you have access requirements?
If yes, please provide us with details.

Please let us know what your requirements are (for example, if you use a wheel-chair or hearing aid).
Will you be attending the HOME VI pre-meeting on Tuesday 10th April (17:30 – 18:30 hours)?
YesNo
Please state which, if any, eczema related scales you currently use, or have used in the past, for routine clinical practice. [If this doesn't apply to you, please write "NA"]

If you don't see patients, please type "NA"

HOME - Harmonising Outcome Measures for Eczema

Centre of Evidence Based Dermatology
University of Nottingham
King's Meadow Campus
Lenton Lane, Nottingham
NG7 2NR, UK

Telephone: +44 115 8232435
Fax: +44 115 8468618
Email: HOME@nottingham.ac.uk