Ball Tree Patient Voice Reference Group

Would you be interested in helping us as part of a Patient Voice reference group?

This would involve occasional requests to answer short questionnaires via email / you letting us know your thoughts about what we can do to improve our services.

We might also ask you to pilot services / consider our ideas and plans for developing the surgery / look at patient letters / advice sheets etc.

We think that this would mostly by email and phone, but it could also involve occasional meetings in person.

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1. Would you like to join Ball Tree Patient Voice Reference Group? (Required.)

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2. How do you describe your Ethnicity e.g. White / Black / Asian

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3. Age - please select which option applies to you

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4. Please let us know your name, date of birth and email / phone number

Your FIRST Name

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5. Your  SURNAME

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6. Your Date of Birth

This is to allow us to put a note on your record to say you are part of the Patient Voice Group

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7. Do you have any particular conditions around which your care is focussed

This will help us contact you when we make changes to specific services.

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8. Would you be interested in helping with volunteering - e.g. supporting other patients in the waiting room / sharing information with local residents / helping with vaccine clinics / other local projects

( this is not a commitment - just an expression of interest )

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9. Your mobile telephone number

(please note we may text or email you links for surveys)

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10. Your landline number

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11. Your email address

(please note we may text or email you links for surveys)

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