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Complete the Patient Group Sign-up Form Online

If you prefer, you can download the sign up form as a pdf document, print it out, complete it and return it to the practice.

download the pdf form


Download the pdf version of our sign up form


Dear Patient
Would you like to have a say about the services provided at North Baddesley Surgery?  I would be very interested to hear your views through our Patient Reference Group. 
By providing your e-mail details we can add them to a contact list, which will mean we can contact you occassionally for feed back.

We would be grateful if you would fill in your details (carefully) on the form provided under the Patient Liaison Group tab, or pick up a copy from reception on your next visit to the Surgery. (All details supplied will be kept securely and only used for the purposes of the Group).

We aim to gather patients from as broad a spectrum as possible to get a truly representative sample. We would like young people, workers, retirees, people with long term conditions and people from non-British ethnic groups.


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