Patient Participation Group Form

Your local surgery needs you!

We are always looking for enthusiastic and willing patients to give us feedback.

If you would like to join the PPG or the next meeting, please complete the form below and a member of the PPG will get back to you as soon as possible.

Title
Age
The information below will help to make sure that we receive feedback from a representative sample of the patients registered at this practice.
How would you describe how often you come to the practice?