Virtual PPG Application Form

An application form for registered patients at Coleridge Medical Centre to join the virtual Patient Participation Group. The virtual PPG will be sent practice related questionnaires on a routine basis, and they will be able to have their say on changes in the practice and feedback any thoughts about current practice procedures.

Last Updated: 26/10/2020

Personal Details

Areas of Interest

This section will help us to determine the surveys best suited to you, and will enable us to send you surveys that would be of most interest to you.

Terms and Conditions

The details that you provide on the virtual PPG application form will be kept completely confidential, and will be stored within the Coleridge Medical Centre database, and we will fully adhere to the Data Protection Act 2018. To agree to become a member of Coleridge Medical Centre's Virtual Patient Participation Group, please sign below. The information you provide us will only be used for matters pertaining to the Virtual PPG. Our privacy notices can be viewed via our website:

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