Call 111 if you need urgent help | Call 999 for an ambulance

Sai Medical
Centre

105 Calcutta Rd,
Tilbury RM18 7QA

East Tilbury
Medical Centre

85 Coronation Ave,
Tilbury RM18 8SW

Corringham
Medical Centre

114 Giffords Cross Rd,
Corringham SS17 7QQ

Signing Up For Patient Reference Group

- Phoenix GP Surgery

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Signing Up For Patient Reference Group

Signing Up For Patient Reference Group

If you are happy for us to contact you periodically by email please fill out all the fields below and send the completed form to us.

The information below will help to make sure that we receive feedback from a representative sample of the patients registered at this practice.
The ethnic background with which you most closely identify is:

About this form   

Fields marked with a red asterisk are
compulsory.

Please note that we will not respond to any medical information or questions received through the survey.

The information you supply us will be used lawfully, in accordance with GDPR Regulations. GDPR gives you the right to know what information is held about you, and sets out rules to make sure that this information is handled properly.

Please note that by using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of registration.

Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential.