PPG Questionnaire

We at Brownlow Health greatly appreciate the views & opinions of our patients and use these as tools to improve our services.
Due to covid we have seen a decline in attendance to our patient participation groups (PPG) and we would like to build these back up to ensure every voice is heard and your ideas are brought to the table.

Name *

First

Last

DOB *

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Postcode *

Which Practice within Brownlow Health you are registered to *Central (Pembroke Place/Ropewalks/Student Health)Kensington Neighbourhood Health CentrePrinces Park Health CentreMarybone Health Centre

Do you have children under the age of 16? *

• Yes
• No

Occupation/Working statusEmployedUnemployedRetiredRefugeeSeeking AsylumOther (please state below)

Other

To help direct us in providing the correct support and information are there any of the below you would like to discuss with Management, clinical or specialist teams?

• 1. Long term conditions
• 2. Cancer referral/Screening and support
• 3. Transgender/LGBTQIA community
• 4. Refugee/Asylum support in registration, Primary Care education and support in translation
• 5. Baby immunisation
• 6. Mental health
• 7. Support for informal carers
• 8. Dementia
• 9. Patients with learning difficulties
• 10. Support for homeless patients
• 11. Referrals for social/health & well being needs such as Weight Management programmes, stop smoking support. Please state below -

Finally – We appreciate people have commitments and it’s not always possible to attend but we value the feedback & therefore to try and get as much participation as possible. We would like to schedule these at a time most convenient to you. Which would work best?

• Virtual
• Face-to-face

Time?

• 4-5pm
• 5-6pm
• 6-7pm

Frequency?

• Monthly
• Bi-monthly (every 2 months)
• Quarterly (every 3 months)

Would you like the option of having all sites come together for a meeting or would you like site specific (Your GP practice only)

• All sites together
• Site specific

Thank you for your time & co-operation. It is greatly appreciated and we look forward to seeing you at one of our PPG meetings soon.

Further communication will follow

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