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Home
Language
Online Services
News
Opening Hours
Contact Us
Menu
New Patients
Appointments
Prescriptions
Patient Record
Services
Health Advice
Online Forms
COVID-19 Latest
Text Reminder Consent Form
Last Updated: 25/09/2019
Your Details
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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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