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.

Name

First Last

Date of Birth

Mobile Phone Number

Your Consent

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.

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