Patient Reference Group
As part of our drive to improve patient experience, we are encouraging patients to give their views about how the practice is doing. In order to understand the opinions of as many patients as possible we are asking if people would like to provide their e-mail address. This information will be used to contact you occasionally by e-mail to ask you some brief questions.
Are you interested in leaving your e-mail details?
If so please fill in your details on the Sign Up Form tab. We will add your e-mail address to a patient contact list. Please note your contact details will only be used for this purpose and will be kept safely and separate from your medical record.
PRG Sign Up Form
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 setting up a virtual patient representation group so that you can have your say. We will ask the members of this representative group some questions from time to time, such as what you think about our opening times or the quality of the care or service you received. We will contact you via email and keep our surveys succinct so it shouldn’t take too much of your time.
We aim to gather around a hundred patients from as broad a spectrum as possible to get a truly representative sample. 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 Reference 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.