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PPG Signup Form

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All questions marked with a * are mandatory

Patient Participation Group Sign Up

Please double check you've entered the correct email address

May be used to identify you

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As the PPG acts independantly to that of the surgery, we will need to pass on your contact details to enable them to get in touch

Privacy Consent

This form collects personal and medical information about you and we use this information to allow the practice team to contact you.
Please read our Privacy Policy to discover how we protect and manage your submitted data.

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Providing NHS Services

Holland House Surgery
Lytham Primary Care Centre
Victoria Street, Lytham
FY8 5DZ

Freckleton Health Centre
Douglas Drive, Freckleton
Lancashire, PR4 1RY

Telephone: 01253 229470