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Please join our  Patient Group

All you will be asked to do is reply to some short questions occasionally and meet with us up to 10 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 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

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

The following Data Notice will also need to be signed. By signing this form you are confirming that you are consenting to the Beaconsfield Road Surgery - Patient Participation Group holding and processing your email address to keep you informed about local health issues and the work of the group. The processing of personal data is governed by the General Data Protection Regulation (the “GDPR”). You can read our Privacy Policy on the Beaconsfield Road Surgery website.

Data notice

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


We are committed to maintaining confidentiality and protecting the information we hold about you. We adhere to the General Data Protection Regulation (GDPR), the NHS Codes of Confidentiality and Security, as well as guidance issued by the Information Commissioner’s Office (ICO).

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