Check your answers before sending your application
Personal details
{{ summaryList({
rows: [
{
key: {
text: "Contact number"
},
value: {
text: "0121 234 5678"
},
actions: {
items: [
{
href: "#",
text: "Change",
visuallyHiddenText: "Contact number"
}
]
}
},
{
key: {
text: "Name"
},
value: {
text: "Joe Bloggs"
},
actions: {
items: [
{
href: "#",
text: "Change",
visuallyHiddenText: "name"
}
]
}
},
{
key: {
text: "Date of birth"
},
value: {
html: "1 January 1980"
},
actions: {
items: [
{
href: "#",
text: "Change",
visuallyHiddenText: "date of birth"
}
]
}
},
{
key: {
text: "Home address"
},
value: {
html: ' Two Snow Hill
Snow Hill Queensway
Birmingham
B4 6GA'
},
actions: {
items: [
{
href: "#",
text: "Change",
visuallyHiddenText: "home address"
}
]
}
}
]
}) }}
Further details
{{ summaryList({
rows: [
{
key: {
text: "Title one"
},
value: {
text: "Details for number one"
},
actions: {
items: [
{
href: "#",
text: "Change",
visuallyHiddenText: "Title one"
}
]
}
},
{
key: {
text: "Title two"
},
value: {
html: "Details for number one"
},
actions: {
items: [
{
href: "#",
text: "Change",
visuallyHiddenText: "Title two"
}
]
}
}
]
}) }}
Now send you application
By submitting this notification you are confirming that, to the best of your knowledge, the details you are providing are correct.
Your details with be sent to Rose Medical Practice to begin your registration.
Accept and send registration