Patient Reference Group

We would like to know how we can improve our service to you and how you perceive our surgery and staff. 

To help us with this, we are setting up a virtual patient representation group so that you can have your say. We will ask the members of this representative group some questions from time to time, such as what you think about our opening times or the quality of the care or service you received. We will contact you via email (or by post if you are not on email) and keep our surveys succinct so it shouldn’t take too much of your time.

We aim to gather around a hundred patients from as broad a spectrum as possible to get a truly representative sample. We need young people, workers, retirees, people with long term conditions and people from non-British ethnic groups.

We will be in touch shortly after we receive your form. Please note that no medical information or questions will be responded to.

Patient Reference Group Sign-up form

Patient Reference Group Sign-up form

Title *

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

Gender
How old are you?
How often to you attend the practice?
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