Patient Participation

Dear Patient,

We would like to know how we can improve our service to you and how you perceive our surgery and staff.

To help us with this, we are looking for patients to set up a patient representation group so that you can have your say, remember this is your surgery!

We will be asking the members of this representative group to meet at the practice from time to time to discuss such things as what you think about our opening times or the quality of the care or service you receive.

We will also contact you via email and keep any surveys brief so it shouldn’t take too much of your time.

We are looking for a number of patients from as broad a spectrum as possible - we need young people, workers, retirees, people with long term conditions and people from non-British ethnic groups.

If you would like to be involved please contact the surgery via Tel No: 0161 272 5660 or alternatively please click the link below to open the sign-up form and complete all the fields:

Download PPG Sign-Up Form (.pdf)

You can also complete the online form below.

1Patient Participation

Name

Address

Postcode

Email(contact will only be conducted by email)

The following information will help to ensure we speak to a representative sample of the patients registered at this practice and you must provide this information.

(contact will only be conducted by email)

Age you?

Male

Female

(contact will only be conducted by email)

Age GroupPlease Choose...Under 1617 - 2425 – 3435 – 4445 – 5455 – 6465 – 7475 - 84Over 84

Which ethnic background do you represent?Please Choose...White - British GroupWhite - IrishMixed - White & Black CaribbeanMixed - White & Black AfricanMixed - White & AsianAsian or Asian British - IndianAsian or Asian British - PakistaniAsian or Asian British - BangladeshiBlack or Black British - CaribbeanBlack or Black British - AfricanChineseAny Other

---

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.

---