Patient Communications Feedback form

We are working to improve the way we communicate and engage with our patients. Our website has been designed with the input of patient and staff feedback.

Please let us know what you think. Please also use this form to let us know what else we can do to give our patients the information they require in a format that suits them.

Last Updated: 24/02/2024

Your Details

Providing us with your name and contact details is optional, but it would be helpful to ensure we understand your suggestions.

Name

Phone Number

Email Address

FEEDBACK

What do you like about our website? *

What information or advice, if any, is missing from our new website? *

Please let us know what else we can do to give our patients the information they required in a format that suits them.

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA. *

I consent to the practice collecting and storing my data from this form.

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Patient Communications Feedback form

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