This form is an expression of interest to join the North West London Partners in Diabetes (PID) group.

Someone from the PID group will follow up this form submission and you will be invited to an informal chat with a member of the group.

To apply to join the PID:

  • You will be over 18 years old.
  • You are registered with a GP practice in North West London (Brent, Ealing, Hammersmith & Fulham, Harrow, Hillingdon, Hounslow, Kensington & Chelsea, or Westminster.
  • You have been diagnosed with diabetes or Non-Diabetic Hypoglycaemia (high risk of type 2 diabetes).

Partners In Diabetes poster
  
 
 
 
 
First Name:*
 
 
 
 
 
 
Last Name:*
 
 
 
 
 
 
Email:
 
 
 
 
 
 
Phone Number:*
 
 
 
 
 
 
GP Practice:*
 
 
 
 
 
 
GP Borough*