We would like to know how we can improve our service to you and how you perceive our surgery and staff.
To help us with this, we are keen to re-establish our patient group. In the past our group has not been as representative as we would have liked, so if you like to be involved in some way please let us have your contact information.
We need young people, workers, retirees, people with long term conditions and people from non-British ethnic groups.
If you are happy for us to contact you occasionally by email please click the link below to open the sign-up form and complete all the fields.
Complete the Patient Group Sign-up Form Online
If you prefer, you can download the sign up form as a pdf document, print it out, complete it and return it to the practice.
Download the pdf version of our sign up form
We will be in touch shortly after we receive your form. Please note that no medical information or questions will be responded to.
Many thanks for your assistance
The information you supply us will be used lawfully, in accordance with the Data Protection Act 1998. The Data Protection Act 1998 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.