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Patient Participation Group Sign-Up Form

If you are happy for us to contact you occasionally by email please complete the online form below.

If you prefer, you can download the sign up form as a pdf document, print it out, complete it and return it to the practice. Click here for the PDF version.

PLEASE NOTE: No medical questions entered into the form in either format will be responded to.

1Patient Participation Group Sign-Up Form

Your help in completing the following would be appreciated, so that we can make sure all our groups of patients are represented as far as possible

Although sending information across the Internet means that privacy of data cannot be absolutely guaranteed, our online forms offer high levels of security. The forms use HTTPS and TLS (using a 2048 bit certificate) to encrypt data sent to and from your computer when using the site and our server environment is PCI DSS certified - the highest standard of security associated with e-commerce and online finance solutions.

Form submissions are stored on the server for 28 days and are encrypted and secured with a private key known only by the GP Practice.

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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