Join Patient Participation Group

Find out more information about the Patient Participation Group (PDF, 367KB)

We would like to know how we can improve our service to you and how you perceive our surgery and staff.

To help us with this, we are setting up a patient participation group so that you can have your say. We will ask the members of this group some questions from time to time, such as what you think about our opening times or the quality of the care or service you received. We will contact you via email initially and then there will be face to face meetings held at the practice quarterly.

We aim to gather around a 25 patients from as broad a spectrum as possible to get a truly representative sample. We need young people, workers, retirees, people with long term conditions and people from non-British ethnic groups.

If you are happy for us to contact you occasionally by email please complete the online form at the end of this page.

If you prefer, you can download the sign up form (PDF, 434KB), print it out and return the completed form to the practice.

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

Your Details

Your name

Date of BirthPlease provide in the format dd/mm/yyyy, for example 18/01/1970

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 and is accessed over a secure connection by nominated staff. We have 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 Rowner Medical Centre • Rowner Health Centre, 143 Rowner Lane, Rowner, Gosport, PO13 9SP.

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.

Local Services