We are encouraging patients to give their views about how the practice is doing, and we would like to be able to find out the opinions of as many patients as possible. To do this we have set up a virtual patient reference group (vPRG).
This is an email community that we can consult on a regular basis. If you would like to be part of this group, and have your say, please send your email address to firstname.lastname@example.org.
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.