Patient Participation Group

If you are interested in becoming a PPG member, please submit your details using the form below. Providing this information will help us to ensure that the PPG is as representative as possible of our practice population as a whole. The information you supply will be used lawfully, in accordance with the UK General Data Protection Regulation (UK GDPR).

What is your name?

Do you know your NHS or patient number?

What is your date of birth?

For example, 15 3 1984.

What is your current postcode?

Which of the following best describes how you think of yourself?

This is an optional question.
We collect this information to ensure that the PPG is as representative as possible of our practice population as a whole.

Which is your ethnic group?

Select one option
or
We collect this information to ensure that the PPG is as representative as possible of our practice population as a whole.

How would you like to be contacted?

This is an optional question.

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

Privacy protection

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.