St Luke's Primary Care Centre

Patient Participation Group

Comments & Suggestions Form

Please note:

• No medical information or questions will be responded to.

Please be assured that your contact details will be kept safely and securely, and not shared with anyone else.

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.

1Patient Participation Group

Name

Contact Number

Email Address

Comments & Suggestions

I consent to the details provided in this form being provided to the PPG.

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Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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