Communication Consent Form Name First Last Date of birth DD slash MM slash YYYY Please use format day/month/year e.g. 12/05/1979Email PhoneYour 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.Your consent 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.Your consent 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.Your consent I understand I can cancel the text message facility at any time.Privacy PolicyThis form collects your name, date of birth, email and other personal information. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.Your consent I consent to the practice collecting and storing my data from this form.Patient’s Signature
