patient access

Sign up to our patient group

NHS 111


Sign Up For Our Patient Reference Group

We would like to know how we can improve the services we provide for you and also 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 this 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 download and print the sign-up form and complete all the fields and return it to the rception team at the surgery or alternatively fill out and submit the online version of the form below.

Online sign up form

* Please note that we will not respond to any medical information or questions received through this form.

First name:
Last name:
Email address*:
Confirm email*:
Telephone number* (no spaces):

The information below will help us make sure that we receive feedback from a representative sample of patients registered at this practice:

Your gender:
Your age:
Are you (select all that apply)?: At school
A parent
A Carer
Do you have a long term condition?:
How often do you come to the practice?:
NHS UK Department of Health NHS West Sussex