Patient Reference Group

As at September 2019 we are actively recruiting new members to join our group.

Our Patient Reference Group is a group of registered patients whom we consult with via occasional emails and at meetings held 2-3 times each year. The aim of the group is to help us to develop and improve our services to patients.

We would like this group to be as representative as possible of our wider Practice population and welcome input from male and female patients of all ages and ethnic origins, workers, unemployed, retired, students, people with long term illnesses or disabilities, carers etc.

If you are a registered patient and would like to be part of this group to help us shape the future of Fairfield Park Health Centre, please email the surgery (

If you are happy for us to contact you occasionally by email please click the link below to open the sign-up form and complete all the fields.

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 formPatient Group Sign-up Form

We will be in touch shortly after we receive your form. Please note that no medical information or questions will be responded to.

Many thanks for your assistance

Kathryn Burbidge

Practice Manager

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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