CULVERHAY SURGERY

Wotton-under-Edge, Gloucestershire

Wednesday, 22 Feb 2012

Patient Reference Group

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

To help us with this, we are setting up a virtual patient representation group so that you can have your say. 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 much of a broad spectrum of patients as possible to get a truly representative sample. 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 be email please download the form below and complete all the fields, before returning to us either by email, post or dropping off at the surgery.

Patient Reference Group Signup Form (right-click to save as)

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

 

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

Contact Us

Culverhay Doctors Surgery

Culverhay Surgery
Wotton-Under-Edge
Gloucestershire
GL12 7LS 

APPOINTMENTS
01453 843 893

EMERGENCIES
01453 843 252

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