Communication Consent Form

If you are happy to receive text message reminders please fill in this form.

Communication Consent

Communication Consent

Declaration

I consent to the practice contacting me by text message and/or email for the purpose 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. I can cancel the text message facility at any time.

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.

If more than one person shares the use of the mobile phone number detailed below, we will need a consent form from each of those people.

By using this form, you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method to notify us of your details.

Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential.

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.