Patient Participation Group Registration

All registered patients are welcome to attend any meeting of the Patient Participation Group giving prior notice. If you are interested in hearing about the activities of the Patient Participation Group but cannot/do not want to attend meetings please complete the form below to receive newsletters and invitations to contribute to the group activities online. This is our “virtual group”.

AGM 23rd February 2023 at 18:00 at the surgery.

Please email enquiry.shmc@nhs.net to register interest. Meeting details will be sent nearer the time.

Please be aware that any replies from the surgery may appear in your junk or spam inbox.

Patient Participation Group Registration

Patient Participation Group Registration

If you are human, leave this field blank.

Full Name: *

Date of Birth:

Please use this date format: DD/MM/YYYY

Phone Number:

Email Address: *

Responses we send will go to this email address

Are you:

Male

Female

How would you describe how often you come to the practice?

Regularly

Occasionally

Very rarely

Ethnic Background:

White British

White Irish

White and Black Caribbean

White and Black African

White and Asian

Indian

Pakistani

Bangladeshi

Caribbean

African

Chinese

Other

Age group:

Under 16

17 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

75 - 84

Over 84