Patient participation group

The aims of the patient participation group

• To offer opinions in a constructive manner and to put forward ideas on behalf of other patients.
• To improve the provision of health care.
• To improve communication between surgery, patients and the wider community about matters concerning the surgery and health in general.
• To provide assistance in development of new services.
• To encourage a spirit of self help and support amongst patients to improve their health and social care.

Join our PPG

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Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

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Date of Birth *

For example, 15 3 1984

you often Name

The information below will help to make sure that we receive feedback from a representative sample of the patients registered at this practice.

Gender *

• Female
• Male
• Transgender

Age Range *

• Under 16
• 17 – 24
• 25 – 34
• 35 – 44
• 45 – 54
• 55 – 64
• 65 – 74
• 75 – 84
• Over 84

Ethnicity *

• White: British
• White: Irish
• Mixed: White & Black Carribean
• Mixed: White & Black Asian
• Mixed: White & Black African
• Asian: Indian
• Asian: Bangladeshi
• Asian: Pakistani
• Black: Carribean
• Black: African
• Chinese
• Other

How often do you visit the practice? *

• Regularly
• Occasionally
• Very Rarely

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