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Communication Consent Form

We would like to keep be able to send you Practice communications by email and text message, but first we need your permission. Please provide your details and consent below. Do not use this form if you are not the patient. If you are a Carer or Patient’s representative please contact the Practice for advice.

Communication Consent
Please use format day/month/year e.g. 12/05/1979

Your Consent

We need to have your consent to begin communicating with you by text or email. Please tick to accept in the boxes below.

Privacy Policy

This form collects your name, date of birth, email and other personal information. 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.