Virtual Patient Participation Group Registration

Dear Patient,

We would like to know how we can improve our service to you and how you perceive our surgery and staff. Your comments and ideas are important to the practice and as part of the virtual patient group – this is the fastest and most efficient way of keeping everyone “in the loop”.

We aim to gather around a hundred patients in our patient group from as broad a spectrum as possible to get a truly representative sample. We need young people, workers, retirees, people with long term conditions and people from non-British ethnic groups.

If you are happy for us to contact you occasionally by email please complete all the fields below and click Submit. Thank you.

Please note that no medical information or questions will be responded to.

The information you supply us with will be used lawfully, in accordance with the Data
Protection Act 1988. The Data Protection Act 1988 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.

Patient Participation Group Registration

Patient Participation Group Registration

Any responses we send will go to this email address.
Are you:
How would you describe how often you come to the practice?
Ethnic Background:
Age group: