The Gold Street Surgery - Join Patient Reference Group

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BBC Health News

Whorlton Hall: Hospital 'abused' vulnerable adults22 May 2019 17:02Undercover BBC filming shows staff swearing, mocking and taunting patients with learning disabilities.
Two female loos for every male one, experts recommend23 May 2019 01:21With more urinals than cubicles, men - unlike women - rarely queue, a report says.
Aspirin 'safe' for brain-bleed strokes22 May 2019 11:12Patients can take aspirin without raising their risk of another stroke, a study suggests.
I lost my arms and legs - stop it happening to others22 May 2019 01:06Sepsis survivor Tom Ray wants better awareness and faster diagnosis of the potentially deadly disease.
'Broken' care system for most vulnerable21 May 2019 02:19Patients with mental health problems, autism and learning disabilities are being let down, a report says.
Don't be complacent over laughing gas risks, say nurses21 May 2019 02:13Nurses are warning drug use can cause breathing and heart problems - and sometimes death.

Join Patient Reference Group

The Gold Street Surgery is in the process of establishing a Patient Reference Group (PRG) to gain the views of our registered patients and ensure they are involved in decisions about the range and quality of the services provided by our practice.

If you are interested in becoming a PRG member, please submit your details using the form below. Providing this information will help us to ensure that the PRG is as representative as possible of our practice population as a whole. The information you supply will be used lawfully, in accordance with the General Data Protection Regulation (GDPR).

Please select the practice location most relevant to this Online Form submission:

1 Your Details

Your name

Date of BirthPlease provide in the format dd/mm/yyyy

Are you able to provide your NHS or Patient Number?This will allow us to locate you quickly on our Patient Database.

NHS Number

E-mail Address

Postcode

Gender

Which of the following ethnic backgrounds do you most closely identify with?

How would you describe how often you come to the practice?

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to
Gold Street - Main Surgery • Gold Street, Saffron Walden, Essex, CB10 1EJ.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

Submit Form