PATIENT INVOLVEMENT
PATIENT GROUP REGISTRATION FORM
Thank you for taking an interest in the Patient Involvement project. Our aim is to engage with as many of our patients as possible to canvas opinion and gather feedback on the services the practice offers.
We are encouraging patients to give their view about how the practice is performing. We would like to find out the opinions of as many patients as possible and are asking if people would like to provide their email address so that we can contact you, by email, every now and again.
If you are interested in being involved please complete the form below. Further information is available on our website or please ask to speak to the Practice or IT Manager.
Name:
EMAIL Address:
Postcode:
DOB:
Would you prefer to be contacted and provide feedback via standard mail rather than electronically?
How would you describe how often you come to the practice?
Once we have established the patient group we will send out further information and focused questions, but in the meantime if there is anything you feel we could improve on, or any topics you feel would be good to bring to the patient group please enter them in the comment box below.
Thank you for taking the time to complete this form and join the patient group. Your opinion is very important to us and we look forward to working with you to help develop our services for the future.
The Castle Place Management Team.