Comment Form

Use this form if you would like to make a comment or suggestion to the practice Staff.

Your Details

Name *

Date of Birth *

How long have you been a patient of Ballards Walk or the Gore?

One year or less

Less than 5 years

More than 5 years

More than 10 years

Your Comment

What is the nature of your comment or suggestion? *

Clinical

Administrative

Other

Please write your comment or suggestion below. *

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data. *

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Page last reviewed: 13 October 2021
Page created: 30 July 2021

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Comment Form

Comment Form

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