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The Scottish Dental Practice Based Research Network

Joining the SDPBRN

If you are interested in joining the Scottish Dental Practice Based Research Network, either now or at a later date, or simply want to find out more, please fill in the form below and we will keep you informed of the development of the network (mostly by e-mail).

Please tell us who you are.

Title

Forenames

Surname

Other details:

Telephone number:

Fax:

Optional details:

	How many years have you been in practice?
	When did you graduate?
	Have you undertaken any post-graduation professional development? Specify please.

Are there any other dentists at your practice who would like to join? Yes No

If so please give their details in the box below, one per line.

Web site access		Practice address:

What is your level of interest? Would like to receive information only at present Willing to consider participating in developed research project Interested in developing a new research proposal Would like to withdraw from the research network

What is your prior research experience?

Which journals do you read most?

You may use this form to join the research network / register interest or to make an alteration to your details on our records.

Please indicate the purpose of your submission Contact us for the first time Make an alteration to your records Withdraw from the network

If your browser does not permit online forms to be submitted directly or if for some reason this option does not operate on your machine, then you can fill out the form, print out a paper copy, and fax it to us on 01382 226550. Our postal address is SDPBRN c/o DHSRU, Dundee Dental Hospital and School, Park Place, Dundee DD1 4HR.