PPG membership

Please complete this form if you wish to join the Patient Participation Group (PPG). The PPG chair will be in touch in due course with welcome information.

Name *

Date of birth *

Telephone number

Email address

Best time to contact you *

morning (9am-12pm)

afternoon (12pm- 4pm)

evening (4pm-7pm)

I confirm that I am a registered patient at Dronfield Medical Practice (DMP) and I agree to share these details with the DMP PPG chair. *

Yes No

Today's date *

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Page last reviewed: 30 April 2025

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PPG membership

PPG membership

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