Find out about our patient group
Shay Lane Medical Centre Patient Group: we would like to know how we can improve our service and how you perceive our surgery and staff. To help us with this, we have set up a virtual patient representation group, so you can have your say. We will ask the members some questions via email from time to time regarding the care and service provided. We are keen to ensure we have a group of around 100 patients from as broad a spectrum as possible to create a truly representative sample.
Patient Group
We have an active patient participation group at our practice.
Join our PPG
We welcome enquiries from patients who would like to join our patient group.
About you
Full name(Required)
First
Last
Email address(Required)
Enter Email
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Postcode(Required)
More about you
This additional information helps us ensure that we speak to a representative sample of the patients registered at the practice.
Would you describe yourself as(Required)
Male
Female
Other
Age group(Required)
under 1617 - 24 25 - 3435 - 44 45 - 5455 - 64 65 - 7475 - 84 over 84
Ethnicity
To help us ensure our contact list is representative of our local community please indicate which of the following ethnic backgrounds you would most closely identify with?
What is your ethnicity?(Required)
White: English, Welsh, Scottish, Northern Irish or British White: Irish White: Gypsy or Irish Traveller Any other White background Mixed or Multiple ethnic groups: White and Black Caribbean Mixed or Multiple ethnic groups: White and Black African Mixed or Multiple ethnic groups: White and Asian Any other Mixed or Multiple ethnic background Asian or Asian British: Indian Asian or Asian British: Pakistani Asian or Asian British: Bangladeshi Asian or Asian British: Chinese Any other Asian background Black, African, Caribbean or Black British: African Black, African, Caribbean or Black British: Caribbean Any other Black, African or Caribbean background Other ethnic group: Arab Any other ethnic group
How would you describe how often you come to the practice?(Required)
Regularly
Occasionally
Very rarely
Not for urgent medical help(Required)
Yes, I understand this form is NOT for urgent medical help
Consent(Required)
By submitting your details you are consenting to providing this information for improving our services to you. The data you supply on this form will be securely stored on our website, which is hosted by a third party. We will retain this information on the website for no longer than 7 calendar days. Your contact details will not be sold or shared with a third party. I understand I can revoke this consent at anytime by contacting the practice. Our privacy policy can be viewed on this website.
I agree to the privacy policy.