PPG Application Form

Complete and submit the PPG application form below to apply for a role within the Patient Participation Group or Virtual Patient Participation Group. The PPG is an active voice for the Village Health Group and allows us to take into consideration the ideas and advice of the local community to give our patients the best care possible. Please note this is NOT a route for complaints, if you wish to make a complaint please follow the complaints procedure.

Last Updated: 10/11/2021

Your Details

Please complete this section as fully as possible so we can contact you with regards to the status of your application.

Name *

Address (Including Postcode) *

Telephone *

Email Address *

Your registered GP practice *

About You

Please complete the sections below to give us an idea of why the PPG could benefit from having you as part of the team.

Please select the practice you would like to represent *

East Leake

Keyworth

Ruddington (Church House)

Sutton Bonington

Please give your reason(s) for wanting to join the PPG *

What knowledge and experience can you offer the PPG *

What other community involvement or outside interests do you have *

Which type of PPG group would you prefer to belong to? *

Virtual PPG ( you do not attend meetings, but you will be sent questionnaires and queries via post, email or text message link)

PPG Patient Connect (you attend scheduled meetings, some of these may be virtual meetings, to discuss opinions and approaches to different agenda items, and you will be included in the agenda) If you submit this option, the PPG will contact you in due course with more information.

Thank you for your interest. I acknowledge that once submitted, my application will be considered based on the experience and diversity I can bring to the group. My application will be treated in confidence. I will be notified of the outcome within a month of submitting the application. *

Yes, I acknowledge the above.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

PPG Application Form

Further Information