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PPG Sign-up Form

PPG Sign-up Form

This additional information will help to make sure we try to speak to a representative sample of the patients that are registered at this practice.

To help us ensure our contact list is representative of our local community please indicate which of the following ethnic background you would most closely identify with?

Thank you.

Please note that no medical information or questions will be responded to.

The information you supply us will be used lawfully, in accordance with the Data Protection Act 1998. The Data Protection Act 1998 gives you the right to know what information is held about you, and sets out rules to make sure that this information is handled properly.


Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


Your Neighbourhood Professionals. Just a Click Away! BMI The Clementine Churchill Hospital
Your Neighbourhood Professionals. Just a Click Away! BMI The Clementine Churchill Hospital