Contact Details Name Address Postcode Preferred contact number This number will be used to contact you to arrange surgery appointment. Preferred e-mail address This will be used to email the surgery report. Customer Reference Number (CRN) e.g. A0000000 CON Number (if known) Please choose from the Surgeries below: Digital Surgery On Farm Surgery ICT Surgery Name of person completing this form Digital Surgery Please choose the surgery from the topics below: - Select -Business PlanningSustainable Farming SchemeLivestock Management & PerformanceGrassland & Crop ManagementHedgerow ManagementWoodland & Agro-Forestry ManagementHorticultureOrganic ProductionHabitat & BiodiversityEnergy & Water EfficiencyRenewable Energy GenerationDiversification, Marketing and Social MediaCarbon AuditingAgri-TechHealth & SafetyHistorical EnvironmentAnimal Health Further details on what you’d like to discuss at the surgery: Please select your advisor On Farm Surgery Please choose the surgery from the topics below: - Select -DiversificationMarketing and Social MediaControl of Agricultural Pollution Paperwork Support (CoAP Paperwork Support)Agri-TechHabitat & BiodiversityHorticultureFresh grassHistorical Environment Further details on what you’d like to discuss at the surgery: Please select your advisor ICT Surgery How would you like to receive your ICT support? - None -Digitally On Farm Have you got internet access? Yes No Further details on what you’d like to discuss at the surgery: Please select your advisor On what basis has this supplier been selected as the most suitable to meet the client’s needs? (Please select all that apply and ensure the selected options reflect the key reasons for selection.) Demonstrated expertise relevant to the client’s specific issue or requirement Relevant sector or farming system experience Existing working relationship or prior engagement and understanding of the client’s business context or circumstances Ability to deliver the required service within the agreed timeframe Geographic location or ability to deliver locally / on-farm Capacity to undertake the work and availability within required timescales Welsh language capability required or preferred Communication style / approach suited to the client Requirement for continuity with previous advice or ongoing work Complexity or sensitivity of the case requiring a particular skillset Please indicate the farming sectors relevant to your business: Arable Beef Dairy Deer Sheep Goats Woodland Pigs Poultry Grassland / Forage only (no animals) Beekeeping Camelids The work will be carried out by a Farming Connect approved independent consultant. By ticking this box, you are confirming that you’re happy for us to share your details with the relevant consultant to arrange the surgery. Submit Leave this field blank
