PPG Signup

If you are a patient registered at Sandy Lane Surgery and St Peter's Medical Practice and are interested in becoming a member of the PPG please complete this sign-up form. We hope you will join us and get involved in making your views on the Practice and local healthcare provision known.

Please note that the PPG is not able to provide medical information or answer specific questions related to any individuals health.

Please select the practice location most relevant to this Online Form submission:

PPG Signup

Name

Email Address

Postcode

Are you a patient registered at Sandy Lane Surgery or St Peter's Medical Practice?

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Sandy Lane Surgery • 77 Sandy Lane, Mansfield, Nottinghamshire , NG18 2LT.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.