Text Reminder Consent Form

Last Updated: 01/05/2024

Your Details

Name *

Date of Birth *

Mobile Number *

Email Address

Consent *

I agree to the practice contacting me by text message for the purpose of health promotion, health management , appointment reminders and chronic disease recalls

Decline consent to the text messaging service

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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Text Reminder Consent Form

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