Patient Participation Group Registration

All registered patients are welcome to attend any meeting of the Patient Participation Group without giving prior notice. 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 - Kintbury & Woolton Hill

If you are human, leave this field blank.

Section

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

Regularly

Occasionally

Very rarely

Ethnic Background:

White British

White Irish

White and Black Caribbean

White and Black African

White and Asian

Indian

Pakistani

Bangladeshi

Caribbean

African

Chinese

Other

Age group:

Under 16

17 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

75 - 84

Over 84

Would you be willing to join our PPG (Patient Participation Group)?

Yes

No

Would you like to receive the minutes of our meetings via email?

Yes

No

Would you be interested in joining a 'virtual' PRG (Patient Representation Group), where you could contribute electronically?

Yes

No

Do you have a special interest in a particular medical condition?

Yes

No

Please provide details:

Are there any issues you would like to see on the agenda?

Yes

No

Please provide details:

Confirmation *

Your contact details will only be used for this purpose and will be kept safely and used lawfully, in accordance with the Data Protection Act 2018 and GDPR. This gives you the right to know what information is held about you and sets out rules to make sure that this information is handled securely.