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groupPatient Participation Group

We would like to be able to contact patients occasionally by email to ask them questions about the surgery and how well we are doing to identify areas for improvement.

download the pdf formPatient Participation Report 31st March 2015

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.

Your contact details will be kept safely and securely and will only be used for this purpose and will not be shared with anyone else.  Should you no longer wish to be on the contact list or leave the surgery, we would ask you to let us know by email if you do not wish to receive further messages.

complete the form 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 form 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.

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