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Shakespeare Road Medical Practice: PPG joiner form

We welcome enquiries from patients who would like to join our patient participation group (PPG). Please fill out the form below to register your interest.

Did you know? Our PPG works with the practice to offer a patient perspective on services, as well as contribute to the continuous improvement of services, foster improved communication between the practice and its patients, and help reinforce messages around taking more responsibility for your health.

You must be a registered patient of Shakespeare Road GP surgery to complete the form below.
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Additional Information

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Ethnicity

To help us ensure our contact list is representative of our local community please indicate which of the following ethnic backgrounds you would most closely identify with?

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How would you like to be involved?

Become a member of the PPG and attend meetings?
Fill in questionnaires by: (Select all applicable)
Be kept informed of educational or other events or changes in the practice by: (Select all applicable)
I would prefer to attend meetings in the: (Select all applicable)
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