Join Our Patient Representative Group
The PRG exists to help all patients and professionals and we need to increase the group of Active Members.
Please complete this form and send it back to the surgery (all information given is strictly confidential within the Practice).
To become an active member, please complete this form:
Join Our Patient Representative 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 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.
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.