Patient Participation Group Registration

If you would like to join our Patient Participation Group please complete our registration form. For further details around the activities of the PPG along with minutes of previous meetings please go to the Patient Participation Group page.

Also if you are interested in hearing about the activities of the Patient Participation Group but cannot/do not want to attend meetings please complete the form below to receive newsletters and invitations to contribute to the group activities online.

Patient Participation Group Registration

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Section

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

Regularly

Occasionally

Very rarely

Are you interested in:

Attending our quarterly meetings?

Becoming an online member?

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