Patient Reference Group

Please fill in the form below if you wish to join our patient reference group

1Patient Reference Group


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.


Allesley Park Medical Centre - 2 Whitaker Road, Coventry, CV5 9JE
University of Warwick (branch site) - University of Warwick Health Centre, University of Warwick, Health Centre Road, Coventry, CV4 7AL www.uwhc.org.uk
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