Communications Consent Form

We want to keep being able to send you Practice communications by email and text message, but first, we need your permission. Please provide your details and consent below.

Last Updated: 31/03/2023

Your Details

Name *

Date of Birth (DD/MM/YYYY) *

Mobile Number *

Email Address *

Your Consent

We need to have your consent to begin communicating with you by text or email.

Please confirm your consent by ticking to accept the options below. *

I consent to the practice contacting me by text message or email for the purposes of health promotion, practice news and for appointment reminders

I acknowledge that appointment reminders by text are an additional service and that they may not be sent on all occasions but that the responsibility for attending appointments or cancelling them still rests with me.

Text messages are generated using a secure facility but I understand that they are transmitted over a public network onto a personal telephone and as such may not be secure.

I understand I can cancel the text message facility at any time.

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA.

I consent to the practice collecting and storing my data from this form.

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Communications Consent Form

We need to have your consent to begin communicating with you by text or email.

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