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West Hallam Medical Centre NHS GP Surgery in Ilkeston

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

Are you:

Male

Female

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

If you are human, leave this field blank.

Form Currently Unavailable

Please note, our forms are available from 8am to 6:30pm, Monday to Friday.

The Village
West Hallam
Ilkeston
DE7 6GR

Get directions

01159 440088

Feedback and complaints

Wellbeing

West Hallam Medical Centre

CQC overall rating

Outstanding

4 October 2016

See the report

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