Application to Join our PPG

As a registered patient, you can use the form below to apply to join the Dr Manickam and Partner's Surgery 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 contact our Practice Manager on 01543 870580.

Contact Address

Dr Manickam and Partner's Surgery
Hednesford Valley Health Centre
Station Road
WS12 4DH

Telephone: 01543 870580