Patient reference group

Dear Patient

We would like to know how we can improve our service to you and how you perceive our organisation and staff. 

To help us with this, we are setting up a virtual patient reference group so that you can have your say. We will ask the members of this representative group some questions from time to time, such as what you think about our opening times or the quality of the care or service you received. We will contact you via email and keep our surveys succinct so it shouldn’t take too much of your time.

We aim to gather around a hundred patients from as broad a spectrum as possible to get a truly representative sample. We need young people, workers, retirees, people with long term conditions and people from non-British ethnic groups.

If you are happy for us to contact you occasionally by email please complete the form below.

We will be in touch shortly after we receive your form. Please note that no medical information or questions will be responded to.

Many thanks for your assistance.

The Phoenix Health Solutions team

If you are happy for us to contact you periodically by email please fill out all the fields below
Title
Postcode
The information below will help to make sure that we receive feedback from a representative sample of the patients registered at this practice.
Your Gender
The ethnic background with which you most closely identify is:
Fields marked with a red asterisk are compulsory.

Please note that we will not respond to any medical information or questions received through the survey.

The information you supply us will be used lawfully, in accordance with GDPR Regulations. GDPR 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 by using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of registration.

Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential.
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