PPG Sign Up

Would you like to have a say about the services we provide ?

The Barnfield Hill Surgery Medical Practice would like to hear your views.

The Practice is setting up a Patient Participation Group. Are you happy to be contacted via email, no more than 5 times a year, to give us your views ?

Questions/enquiries might be about:

  • The services we provide and any proposed changes.
  • Setting our priorities for the future.
  • Helping to agree questions for wider patient surveys.

If you want to help, please fill in the details below and we will add your email address to our contact list.  Make sure all fields marked (required) are completed, otherwise the form cannot be sent.

Name (required)

Email Address(required)

Postcode

Additional information:

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

To help us ensure our contact list is representative of our local community please indicate which of the following ethnic backgrounds you would most closely identify with?

What is your ethnicity

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

 regularly occasionally very rarely

It is important that the Patient Participation Group represents all patients and does not become a place to air personal grievances. Therefore we would ask that you agree our Code of Conduct for the Group.
Please read the Code of Conduct document linked here
 yes I have read and agree to abide by the PPG Code of Conduct

Thank you very much for working with the Practice.
Please note that no medical information or questions will be responded to. 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.