Patient Group
 
 
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  LATEST NEWS  
 

 NEW Patient Participation Group & Survey Results
 Read more here
 
 

 
 
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Patient participation can benefit both our patients and the practice. Having a patient participation group creates a connection between our practice and our patients; allowing us to have direct access to information on your needs and perspectives.

If you are happy for us to contact you periodically by email please fill in your details below.

please read this notice: This form is not sent via a secure server and is just like sending a normal email. Complete confidentiality can not be guaranteed. 
 
Patients Name*  
Date of Birth*    
Address    
Home Tel.    
Mobile Tel.    
Email Address    
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. 		 
   
* You must provide this information.

This additional information will help to make sure we try to speak to a representative sample of the patients that are registered at The Elms.

Please tick appropriate boxes:
 		  
Are you? Male Female  
       
Age group      
Under 16 17-24
25-34 35-44
45-54 55-64
65-74 75-84
Over 84    
       
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?
 
How would you describe how often you come to the practice?
 
 		  
Thankyou
 		  

                          

 
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Information on this website is for registered patients only and should not be used as a substitute for seeking advice from a GP. 
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