Application to Join our PPG

As a registered patient, you can use the form below to apply to join
the Mansion House Surgery Patient Participation Group:



Male: Female:
How would you describe how often you come to the Practice?:
Regularly: Occasionally: Very Rarely:
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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.

Information

Do I Need to Use this Form to Join?

No, you can also apply in writing to our postal address, or call 01785 815555 and ask to speak to Mandy Mitchell.

Surgery Address

Mansion House Surgery
Abbey Street
Stone
Staffordshire
ST15 8YE

Telephone:
01785 815555