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Patient Reference Group registration

Patient Reference Group Registration

Section

How would you describe how often you come to the practice? *
Age group: *
I give my consent for SMS text messaging *

Declaration

I would like to be involved in the Patient Reference Group (PRG) and give consent for the GP Practice to contact me by e-mail (or post, if applicable). I can leave this group at any time by notifying the practice. I can remain a member of this group only while I am a registered patient of the practice. I agree to attend at least two thirds of all Patient Reference Group meetings including the AGM (not required for PRG).
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.

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