Application to Join our PPG

As a registered patient, you can use the form below to apply to join the Shirland Road Medical Centre Patient Participation Group:

Male: Female:
How would you describe how often you come to the Practice?:
Regularly: Occasionally: Very Rarely:
Please enter the code shown above:

Terms & Conditions: By entering the code above, you also confirm that you have read and agree with the Terms and Conditions (including Privacy & Cookies Policies and Medical Disclaimer) for this website.


Do I Need to Use this Form to Join?

No, you can also apply in writing to our postal address, or call 020 8969 2626 and ask to speak to our Practice Manager.

Contact Address

Shirland Road Medical Centre
321 Shirland Road,
W9 3JJ

020 8969 2626