Dorridge Surgery - Patients Reference Group

Would you like your voice to be heard about the care you receive from the team at Dorridge Surgery and the medical services provided locally?

We are creating a Patient Referrence Group to establish a dialogue between Patients and the Surgery team. This will take the form of emails sent from the surgery, to keep you informed of news, information about the Patient Participation Group and asking for your opinions on services offered by the Practice.

If you are interested in joining the group please complete the form below.

Name:

Email

Post Code:

NHS Number

Are you:

MaleFemale

Age:

How often do you come to the surgery?

6 times a year or more2 to 5 times a yearOnce a Year or less

Can you tell us what your priorities are regarding your health care provision?

To ensure our contact list is representative of our local community, please indicate which of the following ethnic groups you would most closely identify with.