Prescribing - achieving value and sustainability - draft guidance: consultation

5. Respondent Information Form

Please Note this form must be completed and returned with your response.

Are you responding as an individual or an organisation?

• Individual
• Organisation

If you are responding as an individual, are you?

• Sufferer
• Carer
• Member of the public
• Clinician
• Other (please specify)
• Prefer not to answer

Full name or organisation’s name:

Phone number:

Address:

Postcode:

Email:

The Scottish Government would like your permission to publish your consultation response. Please indicate your publishing preference:

• Publish response with name
• Publish response only (without name)
• Do not publish response

Information for organisations:

The option 'Publish response only (without name)’ is available for individual respondents only. If this option is selected, the organisation name will still be published.

If you choose the option 'Do not publish response', your organisation name may still be listed as having responded to the consultation in, for example, the analysis report.

We will share your response internally with other Scottish Government policy teams who may be addressing the issues you discuss. They may wish to contact you again in the future, but we require your permission to do so. Are you content for Scottish Government to contact you again in relation to this consultation exercise?

• Yes
• No