Patient Participation Group (PPG) – Application Online Form to join the PPG Application to join Tollgate Medical Centre Virtual PPG and agree to the terms of the group. Are you registered as a patient at Tollgate Medical Centre? Yes No Name First Surname Postcode Email Enter Email Confirm Email Please enter your e-mail address to be used in order to contact you in relation to the Patient Participation Group. IMPORTANT – By providing your e-mail address you are agreeing that this can be passed to the current PPG Chair.Contact NumberPlease enter a mobile number in order for us to send patient participation group text messages.Do you agree to the rules of the group? No sharing of medical information or requests for medical advice No offensive or abusive language – Agree to be kind and courteous and respect the views of others The PPG is not a complaints forum. No raising individual complaints Respect the groups and practice privacy/confidentiality at all times I have read and understand all practice privacy and data protection policies available ALL boxes must be ticked by way of agreement.Consent I consent to my information being used for the purposes described above and wish to submit this online form to Tollgate Medical Centre, 220 Tollgate Road, Beckton, London, E6 5JSInformation submitted through secure forms is used only for the purposes of processing your request and retained for the entirety of your involvement on the Patient Participation Group as a record of joining and agreement to terms. We may be in touch with you in relation to the information submitted. All Information submitted through secure forms is accessed over a secure connection by nominated staff and then held on a password protected file on the practice intranet. We have a strict confidentiality policy. This information is not shared with any external third party organisations other than the chair and committee members of the Patient Participation Group who are practice volunteers. Information is retained in online format for up to 28 days before being transferred to the practice intranet system by way of record keeping for active PPG members.