Gladstone Street, Ilkeston, Derbyshire, DE7 5QS.   Tel: 0115 932 0248, Appointments :0115 850 8880

Dear Patient,

We would like to know how we can improve our service to you and how you perceive our surgery and staff.

Our PPG are setting up this virtual patient representation group in the hope to attract more PPG members who cannot always attend their meetings in the surgerya . 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 as many patients from as broad a spectrum as possible to get a truly representative PPG group. 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 click the link below to open the sign-up form and complete all the fields.

Complete the Patient Group Sign-up Form Online

If you prefer, you can download the sign up form as a pdf document, print it out, complete it and return it to the practice.

Download the pdf version of our sign up form

We will be in touch shortly after we receive your form. Please note that no medical information or questions will be responded to.

Many thanks for your assistance
Patient Participation Group

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.