Join The Patient Participation Group

If you are happy for us to contact you periodically by email please leave your details below and hand this form back to Reception.
This additional information will help to make sure we try to speak to a representative sample of the patients that are registered at this practice.
To help us ensure our contact list is representative of our local community please indicate which of the following ethnic background you would most closely identify with?
If you feel you represent a particular section of the community e.g. a carer, an ‘expert patient’, belong to a charitable organization or club, a single parent, disabled ( please specify the nature of the disability ), live in a residential home etc and are willing to disclose this please enter this below as we are keen to ensure we have representation from all parts of the community.
Thank you.

Please note that no medical information or questions will be responded to.

The information you supply us with 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.

Contact Details

Main Lines: 01959 524633
Appointment Line: 01959 523929

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