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 Would you be interested in joining a patient reference group to help us improve our service to you?


We will be setting up a patient reference group so that you can get involved and have your say.

We would like to recruit patients for our reference group from as broad a spectrum as possible to get a truly representative sample.

We need younger and older patients, patients that work, patients that don’t work, patients that care for others, patients with long term conditions and patients from non-British ethnic groups.

If you would be interested in being contacted by email or letter please fill in our online sign up form or filling in a form at reception.

We will contact you periodically by email or letter and may in the future arrange face to face meetings with the group quarterly.

patient survey

If you are happy for us to contact you occasionally by email please click the link below to open the sign-up form and complete all the fields.

complete the form Complete the Patient Group Sign-up Form Online

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.

download the pdf form Download the pdf version of our sign up form


We will be in touch shortly after we receive your form. Please note that no medical information or questions will be responded to.

Many thanks for your assistance

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 information is held about you and sets out rules to make sure that this information is handled properly.



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