PPG Membership Application

Non-urgent advice: PPG Membership Application

Complete and submit the PPG application form below to apply for a role within the Patient Participation Group.

The PPG is an active voice for patients at Elm House Surgery & Cator Medical Centre. It allows us to take into consideration the ideas and advice of the local community to give our patients the best care possible.

Please note this is NOT a route for complaints, if you wish to make a complaint please follow the complaints procedure.

Your Details

Please complete this section as fully as possible so we can contact you with regards to the status of your application.
Current Address
Registered Practice


Membership of the “core” group involves attending at least 50% of meetings a year and active involvement in the running of the group.

Membership of this group is subject to vacancies arising.

“Virtual” members are consulted by email on a variety of issues and receive email updates from the “core” group; they do not attend any meetings.

I would like to apply to become a member of the:

About You

Please complete the sections below to give us an idea of why the PPG could benefit from having you as part of the team.


The PPG membership aims to be socio-demographically representative of the patient population – please help us to consider your application by ticking the relevant boxes below.
How would you describe your gender?
Do you have children of school age living at home?

Thank-you for your interest!

Please PRINT your full name