Sign Up to the Patient Group

 

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Patient Participation Group Sign Up

If you are happy for us to contact you periodically by email please complete this form

Please double check you've entered the correct email address

Please note that we will not respond to any medical information or questions received through the survey.

 

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.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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