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PPG Signup Form

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All questions marked with a * are mandatory

Patient Participation Group Sign Up

Please double check you've entered the correct email address

May be used to identify you

Which patient group would you like to sign up for: *

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As the PPG acts independantly to that of the surgery, we will need to pass on your contact details to enable them to get in touch

Privacy Consent

This form collects personal and medical information about you and we use this information to allow the practice team to contact you.
Please read our Privacy Policy to discover how we protect and manage your submitted data.

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Providing NHS Services

The Care Quality Commission Inspected and rated Good

Rectory Road Site
201 Rectory Road
Pitsea, Basildon
Essex, SS13 1AJ

Telephone: 01268 727736

Pattiswick Square Site
Pattiswick Square
Basildon
Essex, SS14 2RJ

Telephone: 01268 520552