Welcome to the Independent Nurse registration page

Please answer all questions as fully as possible, then click the 'register' button on the bottom of the form. This form will take approximately 3 minutes to complete.

Note: The fields marked X must be completed

Name : X
Job Title : X
Company Name : X
Department :
Address : X
Postcode/Zip : X
Country : X
Business Tel : X
Business Fax :
Business Email : X

1. Which industry sector do you work in?

tick one only X
Primary care
Secondary care
Private sector
Other

2. Job function

tick one only X
District nurse Nurse practitioner
Practice nurse Health visitor
Community staff nurse Specialist nurse
Nurse consultant Clinical nurse
Other

3. If you are a specialist nurse, clinical nurse or nurse consultant please indicate your specialist area(s)

tick all that apply X
Respiratory medicine Diabetes
Tissue viability Travel health
Stoma care Continence
Oncology Cardiovascular disease
Infection control Urology
Palliative care A & E
Mental health Dermatology
Wound care Women's health
Other

4. Do you have a special interest, see patients or run a clinic in the following areas?

tick all that apply X
Allergy Asthma
Cardiovascular disease/rehab Communicable diseases
Continence care COPD
Dermatology Diabetes
Diet/nutrition/obesity Family planning
Learning disabilities Men's health
Mental health Mother & baby
Occupational health Oncology
Palliative care Sexual health
Smoking cessation Stoma care
Tissue viability Travel vaccinations
Women's health Wound care
None of the above

5. Do you decide on suitable treatments or prescribe in the following areas?

tick all that apply X
Allergy Asthma
Cardiovascular disease/rehab Communicable diseases
Continence care COPD
Dermatology Diabetes
Diet/nutrition/obesity Family planning
Learning disabilities Men's health
Mental health Mother & baby
Occupational health Oncology
Palliative care Sexual health
Smoking cessation Stoma care
Tissue viability Travel vaccinations
Women's health Wound care
None of the above

6. Prescribing qualifications

tick all that apply X
Community Practitioner (District nurse or health visitor prescriber)
Independent nurse prescriber (Formerly extended and/or supplementary prescriber)
No prescribing qualification

7. Are you currently enrolled on an nurse independent/supplementary prescribing course?

tick one only X
Yes
No

8. Do you intend to undertake a nurse independent/supplementary prescribing course?

tick one only X
Yes
No

9. Are you a member of the Association for Nurse Prescribing (ANP)?

tick one only X
Yes - please state membership number
No

10. On average, how many prescriptions do you write in a week?

tick one only X
None
1 - 10
11 - 20
21 - 30
31 - 40
41 - 50
51+

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