Patient Collaboration Form

Company

This field is for validation purposes and should be left unchanged.

What would you like to do?(Required)

What would you like to do?

Give feedback to our Good Ideas Desk

Join a patient group

Volunteer

Please note
This form is not to be used to submit the following:

Queries about your direct medical care, including requests for appointment booking, administration queries and direct messaging to our clinicians

Please use our Anima service for these purposes

Formal Complaints about your individual care

Please follow our Complaints Procedure

Feedback to our Good Ideas Desk
Submit your thoughts, ideas and suggestions to Foundry. Let us know how you think we can improve healthcare in our community.

Join a Patient Group
Insight Groups, Community Forums, Patient Surveys - Your experiences can help us to develop our services.

Volunteer
Become a Foundry Volunteer! We are seeking a practical support network of patients, who may be happy to give a little time and energy to improve local healthcare.

Relevant fields loaded below

Personal details

Title

First name(s)

Last name

Your feedback

Age range

Gender

Pronouns

Pronoun

Ethnicity

White sub-group

White - other

Mixed multiple ethnic groups sub group

Mixed multiple ethnic - other

Asian / Asian British sub group

Asian - other

Black / African / Caribbean / Black British sub group

Black / African / Caribbean - other

Other ethnic group - other

Locality

Surrounding area

Areas of interest for Patient groups

Areas of interest

Patient Representative Group

Insight groups

Volunteering Choice

Patient Representative Group - A mixed group that can regularly meet or be contacted to contribute thoughts and suggestions to relevant issues as they arise.
Insight Groups - Focus groups concentrating on particular areas of development within the organisation.
Volunteering - this could be assisting the surgery in the promotion and running of events, health campaigns or giving time and support to other patients.

If you do wish to get involved it would help us to know a bit more about your individual interests and how you would like to contribute, please see the suggestions below and choose as appropriate:

Are you interested in any of the following

Which of the following are you interested in

Other related interests

Please add your interest here

List medical conditions you are interested in

Volunteering

Volunteering

Assist in promoting health campaigns

Assist in promotion and running of local events or regular community groups

Give time and offer support to other patients

Support our staff during larger clinics, such as those for mass vaccination

Help with Fund Raising

Other - Let us know how you would like to help.

Let us know how you would like to help.

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