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Patient Participation Group Signup

We would like to know if you think we can improve our service to you.

To help us with this, we are setting up an online patient representation group so that you can have your say. We will ask the members of this group some questions from time to time, such as what you think about the quality of the care or service you received.

We will contact you via email and keep our surveys short so it shouldn't take too much of your time. We aim to get opinions from lots of our patients. We need young people, workers, retired people, people with long term conditions (such as Asthma & Diabetes) and people from non-British ethnic groups.

If you are happy for us to contact you occasionally by email please fill in the details below and we will add you email address to our list.

Have your say on how the practice is run

Your Details
Please provide in the format dd/mm/yyyy, for example 18/01/1970
This will allow us to locate you quickly on our Patient Database.

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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