Patient Participation Group Registration

All registered patients are welcome to attend any meeting of the Patient Participation Group without giving prior notice, however if you would like to bring items to be discussed at the meeting, prior notification is required to ensure the best possible discussion. If you would like to register your interest to become a member of the PPG, please complete the online form.

Patient Participation Group Registration

Patient Participation Group Registration

If you are human, leave this field blank.

Full Name: *

Postcode:

Phone Number: *

Email Address: *

Any responses we send will go to this email address.

Are you:

Male

Female

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

Regularly

Occasionally

Very rarely

Ethnic Background:

White British

White Irish

White and Black Caribbean

White and Black African

White and Asian

Indian

Pakistani

Bangladeshi

Caribbean

African

Chinese

Other

Age group:

Under 16

17 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

75 - 84

Over 84

I would like to attend PPG meetings

I would like to join the Virtual PPG (VPPG)