Patient Participation Group

The group meets regularly at the surgery, and also has online members willing to contribute their views. It is an open friendly group and we distribute minutes and other information and news online. We aim to keep patients well informed about NHS pressures, changes and developments.

If you would like to join our group, please complete the following application form and we will then register you to be included in our group. Your contact details will be kept safe.

Please be aware that by completing and submitting this form you are acknowledging you are happy for your name and contact details to be shared with our patient group representatives.

Registration Form

(by providing this number you are consenting to us contacting you by text if necessary)
Are you male or female?  
What age are you?  
Which of the following best describes your ethnic background?  
Please Specify  
How would you describe how often you come to the practice?  
Are you a parent/guardian of a child under 18 years of age?  
Do you consider that you have a disability?  

The information you supply us will be used lawfully, in accordance with the Data Protection Act 2018. The Data Protection Act 2018 gives you the right to know what information is held about you, and sets out rules to make sure that this information is handled properly.

Fields marked with an asterisk (*) are mandatory