This website uses cookies to function correctly.
You may delete cookies at any time but doing so may result in some parts of the site not working correctly.

groupPatient Reference Group

download the pdf formClick here to read the PRG Report for 2014/15

If you would like to volunteer and join the group, to become involved in the development and improvement of the practice and its services, then please ask at Reception for a Patient Reference Group application form.

We will be meeting about four times per year, but arrangements can be made for members that are unable to attend in person, but feel they would like to contribute.

If you are happy for us to contact you occasionally by email please click the link below to open the sign-up form and complete all the fields.

complete the form Complete the Patient Group Sign-up Form Online

If you prefer, you can download the sign up form as a pdf document, print it out, complete it and return it to the practice.

download the pdf form Download the pdf version of our sign up form

We will be in touch shortly after we receive your form. Please note that no medical information or questions will be responded to.

Many thanks for your assistance


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.

Call 111 when you need medical help fast but it’s not a 999 emergencyNHS ChoicesThis site is brought to you by My Surgery Website