Patient Participation Group Form

Please note:

  • No medical information or questions will be responded to.
  • Individual complaints cannot be dealt with through the Patient Group.

Complaints should be addressed to the Practice Manager.

Copies of our complaints procedure can be requested from the practice.

Please be assured that your contact details will be kept safely and securely, and not shared with anyone else.

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.

Patient Participation Group Form

I would like to join the:

Ethnic Origin - I would describe my ethnic origin as follows: (please tick as appropriate)

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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John White Funeral Directors Cloudy2Clear Northampton Ltd