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:
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.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.