The Westwood Road Practice

Patient Reference Group

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

To help us with this, we are setting up a virtual patient representation group so that you can have your say. We will ask the members of the 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 click the link below to open the sign-up form and complete all the fields.

Signing up for our Patient Reference Group

Name: Email Address: Telephone: Postcode: The information below will help to make sure that we recieve feedback from a representative sample of the patients registered at this practice. Your Gender: Male Female 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: White: British Group Irish Mixed: White & Black Carbbean White & Black African   White & Asian     Asian or Asian British: Indian Pakistani   Bangladeshi     Black or Black British: Caribbean African Chinese or Other: Chinese Any Other How would you describe how often you come to the practice? Regularly Occasionally Very rarely

If you prefer, you can download the sign up form as a pdf document, print it out, complete it and return it to the practice.

DOWNLOAD THE PDF VERSION OF OUR SIGN UP FORM

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