Join the Group

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 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.

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.

The group is currently seeking to attract new members, so if you are interested, then please complete the form below.

General Information

 

Age and Gender Details

  • The information below will help to make sure that we receive feedback from a representative sample of the patients registered at this practice.
 

Ethnic Background

 

Use of Medical Centre

 

Verification