We are looking for a representative group of patients that we can interact with through our Patients Forum when we have questions or ideas about the future direction of the practice. If you would like to be included in this panel, you will receive quarterly newsletters from us during the year highlighting the topics discussed on the Patients Forum. If you are happy for us to contact you with this feedback, please leave your details below or download, complete and hand this form back to Reception or pop it in the post to us.

N.B: This is primarily hoped to be an on line discussion group, so do please sign up to join our Patients Forum. For those who can not participate on line or by email, a postal option is available as an alternative. We will not display your email address or name to other members of the panel nor pass on your email address or name to anyone else.

PPVP Sign-up form

Thank you!
The Practice Manager or Reception Manager will contact you by email/post to confirm your place on the new panel during and will provide further details of what happens next.
• Please note that no medical information will be given nor medical questions responded to through this forum.
• The information you supply to us will be used lawfully and in accordance with the Data Protection Act 1998.