We want to ensure that the views of patients and carers are being fed into the practice regarding the services we deliver and any changes or new services that are being considered.

To do this we are compiling a contact list of email addresses so that we can contact you by email every now and again to ask you a question or two.

Are you interested in giving your views?

Please provide your contact details on this form; we will only use information to contact you and will keep your details safely.

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This additional information will help to make sure we try to speak to a representative sample of the patients registered at this practice.

Are you?
Are you?

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 often do you come to the practice?

Thank you.

Please note that no medical information or questions will be responded to.

The information you supply us with will be used lawfully, in accordance with the Data Protection Act 1988. The Data Protection Act 1988 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

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