PPG contact consent v1

This form offers your consent to be contacted by members of the PPG for any business relating to the practice.

Consent To Be Contacted Regarding Practice Matters

This form offers your consent for a member of the PPG to contact you relating to any business or services at the surgery.. This will mainly be used to gather your views and opinions.

Name *

Date of Birth *

Phone Number

Email Address *

Your Comment

Any other supporting information or general interest to be contacted about.

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data. *

I consent to the practice collecting and storing my data from this form.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Page last reviewed: 08 June 2021

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PPG contact consent v1

PPG contact consent v1

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