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Demo clinic
Multi Specialty Clinic
Patient Participation Group registration
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?
Under 16
17 – 24
25 – 34
35 – 44
45 – 54
55 – 64
65 – 74
75 – 84
Over 84
Submit
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