Patient Representative Group

The PPG exists to help all patients and professionals and we need to increase the group of Active Members.

Please complete this form and send it back to the surgery (all information given is strictly confidential within the Practice).

To become an active member, please complete this form:

Your Details
Please provide in the format dd/mm/yyyy, for example 18/01/1970
This will allow us to locate you quickly on our Patient Database.

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


Your Neighbourhood Professionals. Just a Click Away! In receipt of the Mobility allowance? You may be entitled to a brand new car even if you cannot drive yourself. Contact a local motability garage today.
Your Neighbourhood Professionals. Just a Click Away! In receipt of the Mobility allowance? You may be entitled to a brand new car even if you cannot drive yourself. Contact a local motability garage today.