Patient Participation Group Registration

If you are interested in hearing about the activities of the Patient Participation Group, please complete the form to receive newsletters and invitations to the group activities.

Patient Participation Group Registration

Patient Participation Group Registration

Title:
Are you:

How would you describe how often you come to the practice?
Ethnic Background:
Age group:

Supporting the PPG

An annual donation of £2.00 per adult or £3.00 family membership is suggested (or more, by choice). This money will go towards the provision of information, equipment, additional services for patients, and regular newsletters for distribution to members. We are a registered charity (No 1075710).

If you are a UK taxpayer we can use Gift Aid to recover tax on your donation and boost this by 25p for every pound you donate. Please indicate if you wish to use Gift Aid below.

If paying by cash or cheque, please do one of the following (cheques should be made payable to "Friends of Parkfield PPG"):

  • Pop it in an envelope with your payment and hand in to Parkfield Reception
  • Post to PPG Membership, Parkfield Medical Centre, The Walk, Potters Bar, EN6 1QH
Taxpayers - Gift Aid
  • I understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.
  • You can cancel this declaration at any time by notifying the PPG in writing.
  • If in the future your circumstances change and you no longer pay tax on your income and capital gains equal to the tax that the charities reclaim, you can cancel your declaration.
  • If you pay tax at the higher rate you can claim tax relief in your Self Assessment tax return.
Newsletters and updates will be sent by e-mail to the address given above.

I wish to renew/join as a member of the Friends of Parkfield Medical Centre PPG. I agree that the information above may be held by the PPG on its Database.

Information given will be used to administer your membership and to send newsletters and other relevant updates. Your information will not be shared with the Practice or any other bodies.