Join our Patient Participation Forum

Our Patient Participation format has changed. We have now adopted a newsletter and survey format for the present. If you would like to receive these newsletters and you have not already opted in please contact the surgery or call us on 01424 755355 or pop into any of our sites during opening hours and ask them to send you an ‘opt-in’ text

The newsletter will be posted on this website. You will be able to find a link to the survey at the bottom of the newsletter, this is the best avenue to provide any feedback to the surgery.

Join our PPG

Patient participation group recruitment form

Facebook
This field is for validation purposes and should be left unchanged.
Name*
Email address*
Post code*
Additional information
This additional information will help to make sure we try to speak to a representative sample of the patients that are registered at this practice.
Are you?*
- Male
- Female
Age group*
Ethnicity
To help us ensure our contact list is representative of our local community please indicate which of the following ethnic backgrounds you would most closely identify with?
What is your ethnicity?*
How would you describe how often you come to the practice?*
- Regularly
- Occasionally
- Very rarely
Consent*
By submitting your details you are consenting to providing this information for improving our services to you. The data you supply on this form will be securely stored on our website, which is hosted by a third party. We will retain this information on the website for no longer than 7 calendar days. Your contact details will not be sold or shared with a third party. I understand I can revoke this consent at anytime by contacting the practice. Our privacy policy can be viewed on this website.
I agree to the privacy policy.
Thank you

Join our PPG

Additional information

Ethnicity

Thank you