PATIENT CARE TEXT MESSAGING & EMAIL 

Would you like to receive appointment reminders / general information about the practice?
If so, please complete and return the consent form to us as soon as possible.

CONSENT FORM

Declaration

I consent to the practice contacting me by text message and or Email for the purposes of health promotion and for appointment reminders.

I acknowledge that appointment reminders by text are an additional service and that these may not take place on all / or on any occasion, and that the responsibility of attending appointments or cancelling them still rests with me. I can cancel the text message / Email facility at any time.

The surgery does not offer a reply facility to enable patient to respond to texts directly.

Text messages are generated using a secure facility however I understand that they are transmitted over a public network onto a personal telephone and as such may not be secure, however the practice will not transmit any information which would enable an individual patient to be identified. 

I agree to advise the practice if my mobile number changes or if this is no longer in my possession.

Patient name………………………………………………………………

Mobile number…………………………………………………………....

Email address...................................................................................

Date of Birth………………………

Date……………………………….

This practice does not share mobile phone contact / Email details with any external organisation

Practice Email Address:  wa87012@nhs.net