Please join our Patient Group
All you will be asked to do is reply to some short questions occasionally and meet with us 6 times a year.
We would like to gather as many patients as possible for this group so that we get a good representation of patients. So whether you are young or old, working or not working, healthy or have long term conditions, we want to hear from you all.
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 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 version of our sign up form
All prospective members will need to read the Beaconsfield Road Surgery Patient Participation Group Confidentiality Policy, Conflict of Interest and Declaration Agreement for Volunteers and sign and return the last page with their registration form.
PPG Confidentiality and conflict of interest policy and consent form
We will be in touch shortly after we receive your forms. 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.