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Mersea Island Medical Practice A branch of The Colte Partnership

Patient Participation Group registration

Patient Participation Group Registration

Required fields are labelled

What is your name? Required

First name

Last name

What is your date of birth? Required

For example, 31 3 1980

Day

Month

Year

What is your sex? Required

As recorded on your medical record

Male

Female

Other

What is your postcode? Required

The one used to register with your GP

What is your phone number? Required

What is your email address? Required

Anyone else with access to your email account may see responses sent to you

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

Regularly

Occasionally

Very rarely

Ethnic Background:

White British

White Irish

White and Black Caribbean

White and Black African

White and Asian

Indian

Pakistani

Bangladeshi

Caribbean

African

Chinese

Other

Age group:

Under 16

17 – 24

25 – 34

35 – 44

45 – 54

55 – 64

65 – 74

75 – 84

Over 84

Do you give permission for the surgery to share your information with the PPGT committee? Required

Yes

If you are human, leave this field blank.

Contact us

To contact us online, please use our Anima service.

32 Kingsland Road
West Mersea
Colchester
CO5 8RA

Get directions

01206 382015

Feedback and complaints

Wellbeing

This service is no longer registered with CQC

View this service's archived profile on the CQC website

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