SMS Reminder Form - Old Station Surgery

Text Reminder Consent Form

Your Details

Name *

Date of Birth *

Mobile Number *

Email Address *

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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Page last reviewed: 25 September 2019
Page created: 30 January 2023

Text Reminder Consent Form

Text Reminder Consent Form

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