PPG Questionnaire

Please provide your feedback to our Patient Participation Group.

Your Details

Name *

What is your gender? *

Male

Female

Other

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA. *

I consent to the practice collecting and storing my data from this form.

Email Address *

More Information

How satisfied are you with the opening hours of the surgery? *

In the last 6 months how have you found the following:

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PPG Questionnaire

PPG Questionnaire

Further Information