PATIENT GROUP PARTICIPATION APPLICATION

If you are happy for us to contact you periodically by email please enter your details below then click the Submit button.

Personal Details

How would you describe how often you come to the practice?

How would you like to be involved?

Become a member of the PPG and attend meetings?
Fill in questionnaires by:
I would prefer to attend meetings in the:

Monitoring Information

We collect some monitoring information because we want to ensure that the PPG is accessible to all patients and representative of the practice population as a whole. Any data you provide will be anonymised and stored securely at the practice. We plan to improve the monitoring information we collect and will do so over time in consultation with patients and local groups.

Are you:
Ethnic Background
Your Age Group

Send Your Request

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