Patient Participation Group

If you are interested in joining the PPG please complete the sign-up form below.

We hope you can join us and get involved in making your views on the Practice and local healthcare provision known

Please select the practice location most relevant to this Online Form submission:

Personal Details

Title

First Name(s)

Surname

E-mail

Telephone

Postcode

The information below will help to make sure that we receive feedback from a representative sample of the patients registered at this practice

Your Gender

Your Age

The ethnic background with which you most closely identify is

How would you describe how often you come to the Practice?

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 and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Spinney Brook Medical Centre • 59 High Street, Irthlingborough, Northants, NN9 5GA.

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.

Key Information

Patient Participation Group

Privacy Protection

Spinney Brook Medical Centre

Woodford Medical Centre