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Queens Park Surgery, 24 The Pantiles, Billericay, Essex, CM12 0UATel: 01277 626446
Would you like to have your say about the services provided at Queens Park Surgery but don't have the time to come to our meetings?
Then you may like to join our Virtual Patient Group and help us shape the future.
We are very proud of our surgery and staff and although we try to do a good job we are always looking at ways to improve our service to our patients. So we are setting up a virtual patient participation group so that you can make suggestions about the way we deliver services to our patients. We would like a wide range of our patients to take part so that the views are representative of the local population.
We would like to email you from time to time to ask your views and we would like as many patients as possible to take part – just leave us your email address and we will be in contact once or twice a year to ask you for your views and what you think is important.
If you are happy for us to contact you occasionally by email please click the link below to open the sign-up form and complete all the fields.
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 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.
Contact the Patient Group with your feedback, suggestion, comment or question. Please do not use
this form for complaints - these should always be directed to the Practice Manager
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 to notify us of your comment.
Your IP address (126.96.36.199) will be sent
with your communication. In rare cases where abuse or criminal activity can be shown
to have taken place this may be used by the authorities to trace you.