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Adelaide Medical Centre

Online Requests

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Adelaide Medical Centre

Patient Participation Group Registration

All registered patients are welcome to attend any meeting of the Patient Participation Group without giving prior notice. If you are interested in hearing about the activities of the Patient Participation Group but cannot/do not want to attend meetings, please complete the form below to receive newsletters and invitations to contribute to the group activities online.

Please note – if you submit this request after 4pm on a working day, it will be opened when we re-open on the next working day. The practice is closed over the weekend.

Required field(s) are indicated by *

Patient Participation Group Registration

Patient Participation Group Registration

If you are human, leave this field blank.

You have not agreed to share your data with this website, please either try to login again and grant the website access or alternatively fill out the form below.

To proceed, you can either use NHS login, which will retrieve your details and will pre-populate the form below:

or continue without NHS login and complete the form below:

About you

Your First Name(s): *

As it appears on your passport.

Your Last Name: *

As it appears on your passport.

Postcode: *

The one used to register with your GP.

Your Date of Birth: *

Your date of birth is required to verify your identity.

Sex: *

Male

Female

Other

As on your medical record.

As on your medical record.

Your Phone Number: *

This phone number will be used for all correspondence relating to this request.

Your Email: *

This email address will be used for all correspondence relating to this request. Please be aware that if you have given anyone else access to your email account they may see responses sent to you.

Please continue completing the form below

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

Patient notice

Please note if you submit this request after 4pm on a working day, over the weekend, or on Bank holidays, it will be responded to when we re-open on the next working day.

The practice is closed over the weekend.

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