BMS Recognised Menopause Specialist Register form

Email address (of the person submitting this form):*

Name of BMS Specialist:*

Job title:*

Menopause clinic details

Name of clinic/practice/service:*

Address line 1:*

Address line 2:

Town/City:*

County/Region:

Postcode/Zip:*

Country:

Clinic telephone number:*

Clinic email address:

Clinic website:

Please indicate type of clinic:* NHSPrivateBoth

Please name any other BMS members who work at this clinic (including their job titles):

Additional information:

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