Patient Group Registration General InformationPlease tick the box(es) below if you would like to join the Patient Group: I am interested in attending the group I would like to receive email updates Title Mr Mrs Miss Ms Mx Dr Other First Names Optional Surname Optional Email Enter Email Confirm Email Contact NumberPostcode Demographic InformationThe information below will help to make sure that we receive feedback from a representative sample of the patients registered at this practice.Gender Male Female Other Your Age Under 16 17-24 25-34 35-44 45-54 55-64 65-74 75-84 85 and over The ethnic background with which you most closely identify is: How would you describe how often you come to the practice? Regularly Occasionally Very Rarely