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Patient Reference Group

Our Patient Reference Group is a group of registered patients who we meet and consult with regularly via email/text and/or at quarterly face to face meetings so that they can help us to plan and develop our services wherever possible to improve the service we provide.

We would like this group to be as representative as possible of our wider Practice population and welcome input from male and female patients of all ages and ethnic origins, workers, unemployed, retired, students, people with long term illnesses or disabilities, carers etc.

If you are a registered patient and would like to be part of this group to help us shape the future of Fairfield Park Health Centre, please contact the surgery, either by phone (01225 331616) or email ( or just pop into reception.

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 form 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 form 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.

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