Patient Participation 'Virtual' Panel
We are looking for a representative group of patients that we can interact with through our Patients Forum when we have questions or ideas about the future direction of the practice. If you would like to be included in this panel, you will receive quarterly newsletters from us during the year highlighting the topics discussed on the Patients Forum. If you are happy for us to contact you with this feedback, please leave your details below or download, complete and hand this form back to Reception or pop it in the post to us.
N.B: This is primarily hoped to be an on line discussion group, so do please sign up to join our Patients Forum. For those who cannot participate on line or by email, a postal option is available as an alternative. We will not display your email address or name to other members of the panel nor pass on your email address or name to anyone else.
View 2013-14 Patient Participation Survey Results
View 2013-14 Action Plan
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.