Contact The PPG Form

Contact the Patient Group with your feedback, suggestion, comment or question. Please do not use this form for complaints - these should always be directed to the Practice Manager.

Please select the practice location most relevant to this Online Form submission:

Your Message

Name

Telephone

Date of Birth

Do you agree to be contacted regarding this matter?

Yes, I agree that you may contact me regarding this matter

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Buckshaw Village Surgery (BVS) • Buckshaw Village Health Centre, Unity Place, Buckshaw Village, Chorley, PR7 7HZ.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.