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Patient Reference Group

Patient Reference Groupcomments

We have in place a patient reference group and wish to enhance the representation of our practice population on this group. We are looking in particular for young parents, young people, employed & non-employed patients, those with disabilities, carers, patients with a chronic disease and patient representatives from ethnic minorities.

What does the group involve?

We are looking to involve patients in decisions made about the services we provide or looking to develop in the future. The group will be able to contribute constructive feedback, opinions, suggestions and have a role in the development of any changes made to existing or new services.

If you are interested in joining our group please complete the form available at reception.

Alternatively, you may wish to give us your email address so that we can seek your opinion on practice related matters. 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.

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If you are interested in joining our patient participation group, you can complete the following form and submit it online, or you can print the sign up form and hand it in at reception. Alternatively, you can leave your details at reception.

complete the form Complete the Patient Group Sign-up Form Online

download the pdf form 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.


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.

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