Patient Participation Group (PPG)

If you are interested in becoming a member of our Patient Participation Group (PPG), please fill out your details below to received invitations to our meetings and information about what will be discussed.

Your Details

Name *

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 *

I consent to the practice collecting and storing my data from this form.

Date of Birth *

Phone Number *

Email Address

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Page last reviewed: 08 August 2024

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Patient Participation Group (PPG)

Patient Participation Group (PPG)

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