We have a Patient Reference Group so that we can get the views of a representative group of patients on what they regard as priority issues for change/development within the practice. This may be about the services we provide, how we provide them or even services that you would like us to provide (subject to funding of course!) either within the practice or within the North Bournemouth locality.
We identify from the group the areas/issues that they feel are a priority, carry out a survey within the group (on the issues identified) and, from the feedback, develop an action plan.
As we are aware of the pressures on everyone’s time, we make this as easy as possible and to communicate with the group via email (or letter if you do not use email). This is usually around 2-3 times in the year. The identity of the members of the group will be known only to the practice.
If you are interested in participating in the practice in this way complete the form below and return it to me? If you would like to discuss this further before deciding, please just give me a call.
Matthew Haden
Practice Manager
01202 574604
PATIENT REFERENCE GROUP
If you would like to join this group (communication will be by email or, if you don’t have an email address, by letter) please complete the form below and hand in to reception.
Name:
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Email Address:
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Postcode:
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The information below will help to make sure that we receive feedback from a representative sample of the patients registered at this practice. Please tick as appropriate. Thank you.
Your Gender: | Male | Female |
Your Age: | Under 16 25 – 34 45 – 54 65 – 74 | 17 – 24 35 – 44 55 – 64 75 – 84 Over 84 |
Are you employed/unemployed ? (Please delete as appropriate)
If employed, what type of work do you do?
The ethnic background with which you most closely identify is:
White | British Group | Irish |
Mixed | White & Black Caribbean White & Asian | White & Black African |
Asian or Asian British | Indian
Bangladeshi | Pakistani |
Black or Black British | Caribbean | African |
Chinese or Other | Chinese | Any Other |
How would you describe how often you come to the practice?
Regularly | Occasionally | Very rarely |
Please list any issues that you feel are a priority:
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Please note that we will not respond to any medical information or questions received through the survey.
The information you supply us will be used lawfully, in accordance with the Data Protection Act 1998.