Patient Participation Group

Use this form to sign up to the Westerhope Medical Group Patient Participation Group (PPG).

You can also download this sign up form, print it out, complete it and return it to the practice - or just speak to a member of the reception staff.

The information you supply will be used lawfully, in accordance with the UK General Data Protection Regulation (UK GDPR).

What is your name?

Do you know your NHS or patient number?

What is your date of birth?

For example, 15 3 1984.

What is your current postcode?

Which of the following best describes how you think of yourself?

This is an optional question.
We collect this information to ensure that the PPG is as representative as possible of our practice population as a whole.

Which is your ethnic group?

Select one option
or
We collect this information to ensure that the PPG is as representative as possible of our practice population as a whole.

How would you like to be contacted?

This is an optional question.

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

Privacy protection

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