Patient Forum Group

Dordon & Polesworth Group Practice has a Patient Forum Group (PFG) to gain the views of our registered patients and ensure they are involved in decisions about the range and quality of the services provided by our practice.

If you are interested in becoming a Patient Forum Group member or simply wish to speak with a member of the Patient Forum Group, please submit your details using the form below. Providing this information will help us to ensure that the PFG is as representative as possible of our practice population as a whole. The information you supply will be used lawfully, in accordance with the Data Protection Act 1998.

1 Your Details

Please provide in the format dd/mm/yyyy
This will allow us to locate you quickly on our Patient Database.

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.


© Dordon and Polesworth Group Practice 2018
Dordon Surgery - 162 Long Street, Dordon, Tamworth, Staffordshire, B78 1QA
Polesworth Surgery - High Street, Polesworth , Tamworth, Staffordshire, B78 1DU
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