Patient Participation Group Registration

All registered patients are welcome to join the Patient Participation Group. If you are interested in joining the PPG, please complete this form and someone will contact you with further details.

Patient Participation Group Registration

Patient Participation Group Registration

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Section

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

Regularly

Occasionally

Very rarely

Ethnic Background:

White British

White Irish

White and Black Caribbean

White and Black African

White and Asian

Indian

Pakistani

Bangladeshi

Caribbean

African

Chinese

Other

Age group:

Under 16

17 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

75 - 84

Over 84

Do you give permission for the surgery to share your information with the PPGT committee? *

Yes

No