Patient Participation Group Registration

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.

If you are interested in hearing about the activities of the Patient Participation Group but cannot/do not want to attend meetings please complete the form below to receive newsletters and invitations to contribute to the group activities online.

Patient Participation Group Registration

Patient Participation Group Registration

Please use this date format: DD/MM/YYYY
Are you:
Age group:
Do you usually attend:
Any responses we send will go to this email address.
By providing your email address you are confirming that you agree to receive emails from the PPG. To unsubscribe to the PPG, please email goringwoodcotePPG@gmail.com and your details will be removed from the membership list.

Optional Information

To help us ensure that our PPG membership reflects our Practice Population
Ethnic Background:
Which of the following describes what you are doing at present?: