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Signing Up For Patient Participation Group

Signing Up For Patient Participation Group
Gender
Please use format day/month/year e.g. 12/05/1979

The information below will help to make sure that we receive feedback from a representative sample of the patients registered at this Practice.

Your Gender
Your age
Your ethnic background

How would you like to be involved?

Become a member of the PPG and attend meetings?
Fill in questionnaires by: (Select all applicable)
Be kept informed of educational or other events or changes in the practice by: (Select all applicable)
I would prefer to attend meetings in the: (Select all applicable)

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.