The Myton Hospices - Education - Spoke Visits / Placements interest form

We offer short placements (spoke visits) to healthcare professionals and AHP/Nursing students.

If you would like to request a spoke visit, please register your interest using the form below.

Your information will be assessed upon receipt and contact made by an appropriate Myton member of staff, to agree on dates and discuss a suitable plan.

Please note: We will make every effort to provide you with a visit, however, we cannot guarantee this.

Title*
First name*
Surname*
Email*
Telephone*
Current post (If student please include stage of training)*
Preferred location*
You can select multiple locations.
- Coventry
- Rugby
- Warwick
- No preference
Please tell us three learning objectives for the placement*
Number of days requested*
Please list the dates you are available*
Do you agree to complete a feedback form if requested, of what has been gained/learned?*
- Yes
- No
Your privacy
We promise to do our best to keep your details safe and secure and will only process your data in accordance with the current Data Protection legislation. Our Privacy Policy explains how we keep this promise and you can read more online at www.mytonhospice.org/privacy-policy If you change your mind about hearing from us please email DSCT@mytonhospice.org or call us on 01926 358383.
I accept The Myton Hospices Privacy Policy*
- I accept

Your privacy

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