Text Messaging Service - Clarence Medical Centre

Text Messaging Consent Form

By completing this form you are consenting to the surgery contacting you by SMS text messaging. This can be for a variety of reasons including: appointment reminders / cancellations / notifications, test results, prescription collection reminders, subject access requests (copies of medical records), referral notifications, etc.

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: 06 March 2020
Page created: 25 November 2019

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Text Messaging Consent Form

Text Messaging Consent Form

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