Join the PPG If you feel you would like to be involved in any way, please complete this form PPG Enrolment Form If you would like to be involved with the PPG please complete the online form or download the printable version and hand in at the reception desk. Your Name (required) Address Telephone Your Email How do you prefer to be contacted? Telephone Post Email To help us ensure our contact list is representative of our local community, please provide the following information. Your answers will be treated in the strictest confidence. Age Sex Male Female Which ethnic group do you belong to? White Black/Black British Asian/Asian British Mixed Chinese Other ethnic group How often do you come to the practice? Regularly Occasionally Very Rarely Please list any interest you have in specific health areas What involvement would you like in this group? Email group only Committee member About This Form Note that by using this form, you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another communication method.