Patient Participation Group Registration

If you would like to join the PPG or if you are interested in hearing about the activities of the Patient Participation Group but cannot/do not want to attend meetings please complete the form below to receive newsletters and invitations to contribute to the group activities online.

For more information, please view our Patient Participation Group Information.

Patient Participation Group Registration

Patient Participation Group Registration

If you are human, leave this field blank.

Your Personal Details

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY

Home Address (include Postcode): *

Phone Number:

Email Address: *

Any responses we send will go to this email address.

I confirm that I am happy for Loddon Vale Practice and it's PPG to securely process my personal information so that you may contact me regarding my application

Your PPG Application

Please select one of the following dropdown options: * I am working part or full time I am looking for work I am unemployed I am unable to work due to a disability I am retired

Please state your job/profession: *

Do you have any children under the age of 16 living at home? *

Yes

No

What skills or experience could you offer the PPG? *

Why do you want to be involved in the PPG? *

How did you hear about the PPG?