Consent for receiving text messages

Complete the form below to be added to our text messaging service.

Last Updated: 07/06/2024

Personal Details

Name *

Date of Birth *

Mobile Number *

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA *

I consent to the statement above

I consent to the practice sending me clinical communications and/or appointment reminders by SMS

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Consent for receiving text messages

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