Dr Shantir’s Practice

020 8520 7115

Join our PPG

We welcome enquiries from patients who would like to join our patient group.

Download and complete the form below, or complete and submit our online form.

For more information contact Amal Shantir on 020 8520 7115

Download a patient group application form

Join our PPG

Patient participation group recruitment form
  • Additional information

    This additional information will help to make sure we try to speak to a representative sample of the patients that are registered at this practice.
  • Ethnicity

    To help us ensure our contact list is representative of our local community please indicate which of the following ethnic backgrounds you would most closely identify with?
  • Thank you

    Please note that no medical information or questions will be responded to. The information you supply us will be used lawfully, in accordance with the Data Protection Act 2018. The Data Protection Act 2018 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.
  • This field is for validation purposes and should be left unchanged.