Join our Virtual Patient Participation Group (VPPG)

Full Name*

Email Address*

Post Code*

Your Branch Surgery*

Would you be interested in joining our PPG?*

PPG members will be required to attend quarterly meetings with the operations manager and clinical lead on site.

Additional Information

This additional information will help to make sure we try to speak to a representative sample of the patients that are registered at this practice

Are you?*

Age Group*

Ethnicity

To help us ensure our contact list is representative of our local community please indicate which of the following ethnic backgrounds you would most closely identify with?

Your Ethnicity

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

Thank You

Please note that no medical information or questions will be responded to. The information you supply us will be used lawfully, in accordance with the Data Protection Act .The Data Protection Act 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.