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Signing Up For Our Virtual Patient Participation Group
If you are happy for us to contact you periodically by email please leave your details below and hand this form in at reception.
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. The Data Protection Act 1998 gives you the right to know what information is held about you and sets out rules to make sure that this information is handled properly.