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.

Last Updated: 08/08/2024

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 *

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Date of Birth *

Phone Number *

Email Address

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Patient Participation Group (PPG)

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