Patient Group

Would you like to have your say about the services provided at St. Mary’s Medical Practice?

If you would like to become part of our patient feedback group and are happy to be contacted by email please complete the form below entering your name, address, telephone number and email address.

Please note: Becoming part of our group would only mean responding to a questionnaire every few months. Your personal details will remain confidential and we will not ask personal medical questions.

complete the form 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

We will be in touch shortly after we receive your form. Please note that no medical information or questions will be responded to.

Many thanks for your assistance

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.

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