Dear Patient,

Here's your opportunity to improve your Surgery! We would love to know how we can make our service better - and what you think of the Practice and its Staff.

To accomplish this, we are establishing a virtual patient representation group so that you can have your say. All we'll do is ask the members of this representative group some questions about the Surgery every once in a while, such as your opinion on our opening times or the quality of the care you received. We'll contact you via email and keep our surveys short - it won't take too much of your time.

We wish to have around a hundred patients from as broad a spectrum as possible to get a truly representative sample. We're looking for young people, workers, retirees, people with long term conditions and people from non-British ethnic groups.

You can download the sign up form as a PDF document, print it out, complete it by hand and return it to the Practice:


We will be in touch with you after we receive your form. Please note that we won't answer any medical questions or provide any medical information in response to this form.

Thank you very much for your help!

Please note: 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.