Virtual Patient Representation Group

We would like to know how we can improve our service to you and how you perceive our surgery and staff.

To help us with this, we are setting up a virtual patient representation group so that you can have your say. We will ask the members of this representative group some questions from time to time, such as what you think about our opening times or the quality of the care or service you received. We will contact you via email and keep our surveys succinct so it shouldn’t take too much of your time.

We aim to gather views from as board a spectrum of patients as possible to get a truly representative sample. We need young people, workers, retirees, people with long term conditions and people from non-British ethnic groups.

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

Personal Details Name:   Email address: Postcode This additional information will help to make sure we try to speak to a representative sample of the patients that are registered at this practice. Are you? Male Female   Age Group Under 16 55-64 17-24 65-74 25-34 75-84 35-44 over 84 45-54     To help us ensure our contact list is representative of our local community please indicate which of the following ethnic background you would most closely identify with? White Mixed Other British White & Asian Chinese Irish White & Black African Other ethnic group - please enter in comments below Other Black background White & Black Caribbean     Other mixed background         Black or Black British Asian or Asian British   African Bangladeshi   Caribbean Indian   Other Black background Pakistani     Other Asian background     How would you describe how often you come to the practice? Regularly Occasionally Very rarely Comments