Dear Patient,

patient survey

Thank you for expressing an interest in joining the Roselawn Patient Group.

We have asked specific questions and additional information in order for us to get a representative sample of the patients that are registered at this practice and of the local community. 

We need young people, workers, retirees, people who attend surgery clinics and people from non-British ethnic groups. If you do not attend the surgery often, we still welcome your views as a patient and invite you to join the Patient Group.

If you are happy for us to contact you please click the link below to open the sign-up form and complete all the fields. (This form is generic and will be used later for the practice survey.)

complete the form Complete the Patient Group Sign-up Form Online

If you prefer, you can download the sign up form as a pdf document, print it out, complete it and return it to the practice.

download the pdf form Download the pdf version of our sign up form


We will be in touch in due course with further information after we receive your form.

Please note that no medical information or questions will be responded to. Nor is it a forum for individual complaints or single issues which should be directed through our complaints procedure.

Thank You.


The information you supply us will be used lawfully, in accordance with the Data Protection Act 1998. The Data Protection Act 1998 gives you the right to know what information is held about you and sets out rules to make sure that this information is handled properly.

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