Patient Participation Group Registration

We would like to know how we can improve our service to you and how you perceive our surgery and staff; if you wish to join our virtual patient representation group please complete this form.

Date of Birth
The information below will help to make sure that we receive feedback from a representative sample of the patients registered at this practice.
Your Age
How would you describe how often you come to the practice?
This field is for validation purposes and should be left unchanged.