North Staffordshire and Stoke Mystery Shopper Programme
Mystery Shopper Registration Form
Surname:
First Name:
Title:
Mr, Mrs, Ms, Dr, Other (Please state)
Address:
Postcode:
Contact telephone number:
E-mail address:
Is your preferred method of
contact telephone or e-mail?
Time of day you prefer to be
contacted
What services are you currently
receiving?
Any other comments
For further information or to complete your registration form over
the telephone, please contact:
Carol Bain, Organisation Development & Innovation Facilitator
Telephone: 01782 652762 or Mobile: 07545 419441
(available Monday to midday Wednesday)
Please e-mail your completed registration form to:
mysteryshopper@northstaffs.nhs.uk
Alternatively post your completed registration form to:
FREEPOST – RTCC-YLAA-KURH
Stoke and North Staffordshire Mystery Shopper Programme
Organisation Development Team
North Staffordshire Combined Healthcare NHS Headquarters
Trentham Business Centre
Bellringer Road
Trentham Lakes South
Stoke on Trent
ST4 8HH