Would you like to find out more about the practice and comment or make suggestions about the services we provide, the surgery and the staff?
To help us with this, we are setting up a patient group so that you can have your say. We will ask members of this group some questions from time to time, such as what you think about our opening times or the quality of the care or service you receive. We will use various methods of contact (based on your preference) and will keep communication brief so it shouldn’t take up too much of your time.
We aim to gather a number of patients from as broad a spectrum as possible to get a truly representative sample of responses. We need everyone - young people, workers, retirees, people suffering from long-term conditions & people from non-British ethnic groups.
We also aim to have 2 or 3 meetings a year so if you'd like to be involved please fill out the form you'll find on reception or email your details to email@example.com and we'll contact you.
If you are happy for us to contact you occasionally by email please click the link below to open the sign-up form and complete all the fields.
Complete the Patient Group Sign-up Form Online
If you prefer, you can download the sign up form as a pdf document, print it out, complete it and return it to the practice.
Download the pdf version of our sign up form
We will be in touch shortly after we receive your form. Please note that no medical information or questions will be responded to.
Many thanks for your assistance
The information you supply us will be used lawfully, in accordance with the Data Protection Act 1998. The Data Protection Act 1998 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.