Patient Group Sign-Up Form

Would you like to help Cedar Practice deliver and develop our patient services?

We are looking for patients from all age groups and social and cultural backgrounds. We already have an active patient participation group and we would like to expand this and gather the views of a wider and larger representation of our practice population.

If you are interested in becoming a part of the Patient Participation Group, please fill in the following form. By completing this form, you consent to be contacted in order to support Cedar Practice as and when required with regard to Patient and Public Involvement.

The information you provide in this form will be processed by Cedar Practice. The information will be treated as confidential and stored in a secure data centre located in the UK. The information will be uploaded to your record in the practice’s clinical system as soon as possible after submission, after which the copy of your information in the data centre will be securely destroyed.

Please 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 method of providing this information.

The information you provide will be processed with the sole purpose of providing you with Direct Care within the surgery and in support of Direct Care elsewhere. Our Privacy Policy provides further detail about how we process your personal information for the purposes of Direct Care.

You have the right to revoke this Consent to the terms laid here, in writing, signed by you. However, such a revocation shall not affect any disclosures we have already made in reliance on your prior Consent.