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Halesowen Medical Practice NHS GP Surgery in the West Midlands

Patient Participation Group registration

Patient Group Registration

Form summary

How would you describe how often you come to the practice? *

Regularly

Occasionally

Very rarely

What is your ethnic group? *

White: British

White: Irish

White: Irish Traveller

White: Traveller

White: Gypsy/Romany

White: Polish

White: Any other White background

Mixed: White and Black Caribbean

Mixed: White and Black African

Mixed: White and Asian

Mixed: Any other Mixed background

Asian or Asian British: Indian

Asian or Asian British: Pakistani

Asian or Asian British: Bangladeshi

Asian or Asian British: Any other Asian background

Black or Black British: Caribbean

Black or Black British: African

Black or Black British: Somali

Black or Black British: Nigerian

Black or Black British: Any other Black background

Other ethnic group: Chinese

Other ethnic group: Filipino

Other ethnic group: Any other ethnic group

Decline to state

Select the option that best describes your ethnic group or background

Provide your ethnic group *

What is your age group? *

Under 16

17-24

25-34

35-44

45-54

55-64

65-74

75-84

Over 84

Terms and conditions *

I confirm that this is not urgent and understand the surgery cannot help while it is closed. If I need help right now, I will visit NHS 111 online or call 111. In an emergency, I will call 999 or go to A&E.

If you are human, leave this field blank.

2 Quarry Lane
Halesowen
West Midlands
B63 4WD

Get directions

0121 550 4917

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