Join the Patient Group All patients are members of the PPG but if you would like to take an active role then please complete the form below. PPG Sign Up Title * Mr Mrs Miss Ms Other Name * Surname * Email * Telephone Number * Postcode * Date of Birth * The information below will help to make sure that we receive feedback from a representative sample of the patients registered at this practice. Gender * Male Female Other Your Age * Under 16 17-24 25-34 35-44 45-54 55-64 65-74 75-84 Over 84 The ethnic background with which you most closely identify is: * How would you describe how often you come to the practice? Regularly Occasionally Very Rarely If you are human, leave this field blank. Submit