We are encouraging patients to give their views about how the practice is doing. We would like to be able to find out the opinions of as many patients as possible and are asking if people would like to provide their email addresses so we can contact you by email every now and again to ask you a question or two.

Are you interested in leaving your email details?

If you could fill in this quick form and hand it back to reception (or provide your details over the phone to me) we will add your email address to a contact list.

Your contact details will only be used for this purpose and will be kept safely.

Please complete the form below and return it to Millfield Surgery for the attention of the Practice Manager, Darren Dalzell.

Documents Section