Patient Participation Group registration

How would you describe how often you come to the practice?

Regularly

Occasionally

Very rarely

What is your ethnic group?

White: British

White: Irish

White: Irish Traveller

White: Traveller

White: Gypsy/Romany

White: Polish

White: Any other White background

Mixed: White and Black Caribbean

Mixed: White and Black African

Mixed: White and Asian

Mixed: Any other Mixed background

Asian or Asian British: Indian

Asian or Asian British: Pakistani

Asian or Asian British: Bangladeshi

Asian or Asian British: Any other Asian background

Black or Black British: Caribbean

Black or Black British: African

Black or Black British: Somali

Black or Black British: Nigerian

Black or Black British: Any other Black background

Other ethnic group: Chinese

Other ethnic group: Filipino

Other ethnic group: Any other ethnic group

Prefer not to say

What is your age group?

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