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Full Name:
Tel (Office):
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Work Address:
Date Of Birth
Subspeciality:
Area of Practice:
Educational Background:
Type Of Institution:
General Hospital   Private Hospital   Private Clinic  
Primary Care Unit   Other   No Answer  
University (non-patient related)   University Hospital  
If you are clinically qualified, please fill in your main areas of interest:
Hepatology   Pancreatology   Inflammatory Bowel Disease  
Lower GI   Nutrition   Coeliac disease / small intestine  
GI Surgery   Oncology   Radiology  
Histopathology   Micropathology   Medical Education  
Hepatobiliary and/or pancreatic Surgery Oesophageal disorders  
Gastro-duodenal disorders   Upper GI motility and functional disorders
Endoscopy   Other   No Answer  
If you are clinically qualified, please fill in your level of experience. Years of resident of fellow in training pre-accreditation:
If you are a Gastroenterologist/Hepatologist, what do you perform?
Gastroscopy   Colonoscopy   ERCP  
Endoscopic Ultrasound Therapeutic Endoscopy   I do not practice Endoscopy
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