HomePatient Participation Group (PPG) Sign up Form Patient Participation Group (PPG) Sign up Form Please complete the form below to join our PPG Group
Tarbock Medical Centre Signing Up For Our Patient Participation Group (PPG) *Title MrMrsMissMsOther *Name Email Address Postcode Phone Number The information below will help to make sure that we receive feedback from a representative sample of the patients registered at this practice. *Your Gender MaleFemale *Your Age style=color:#000000;>Under 1617 to 2425 to 3435 to 4445 to 5455 to 6465 to 7475 to 84Over 84 The ethnic background with which you most closely identify is: White British GroupIrish Mixed White & Black CaribbeanWhite & Black AfricanWhite & Asian Black or Black British CaribbeanAfrican Chinese or Other ChineseAny other How would you describe how often you come to the practice? RegularlyOccasionallyVery Rarely Are you happy for us to contact you by email? YesNo Thank you 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. Send
