PPG Signup

If you are interested in receiving information online about the PPG please complete the sign-up form. We hope you join us and get involved in making your views on the Practice and local healthcare provision known. If you are happy for us to contact you periodically, please complete the details on the form below.

Please select the practice location most relevant to this Online Form submission:

PPG Signup

Name:

Email Address:

Postcode:

This additional information will help to make sure we try to speak to a representative sample of the patients that are registered at this practice.

Gender:

Male

Female

Age Group:

To help us ensure our contact list is representative of our local community please indicate which of the following ethnic background you would most closely identify with?

Ethnic Background:

How would you describe how often you come to the practice?:

Please note that no medical information or questions will be responded to.

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 informatio

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 and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Stag Medical Centre • 162 Wickersley Road, Rotherham, S60 4JW.

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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