Patient Participation Group Registration

The Friends of Parkwood Surgery aims to represent all its patients: please support us by joining FPS and supporting our events and initiatives.

This is your Patient Participation Group. There are over 17,000 patients in this Practice but for FPS to make a difference we need input from you in the form of ideas, feedback and volunteers even if it’s just to help with tea and coffee. Together we can make a significant and positive difference to the benefit of the Practice and all its members.

Patient Participation Group Registration

Patient Participation Group Registration

If you are human, leave this field blank.

Full Name: *

Postcode:

Phone Number:

Email Address: *

Any responses we send will go to this email address.

Are you:

Male

Female

How would you describe how often you come to the practice?

Regularly

Occasionally

Very rarely

Ethnic Background:

White British

White Irish

White and Black Caribbean

White and Black African

White and Asian

Indian

Pakistani

Bangladeshi

Caribbean

African

Chinese

Other

Age group:

Under 16

17 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

75 - 84

Over 84