Communications Consent Form

We would like to keep be able to send you Practice communications by email and text message. Please complete this form to provide your consent for us to do so.

Not only is it a quick and low-cost way for the NHS to contact patients, but it also saves patients time waiting on the phone to get through to the Practice or having to visit the surgery.

The Practice may use text messages to

Send appointment reminder messages – this reduces the chance of you missing a necessary health appointment and avoids wasted appointment times that another patient could use.
Provide you with the opportunity to book directly into clinics such as Winter flu vaccination clinics, request COVID Booster vaccinations or NHS Health checks.
Offer digital health management apps to support you in managing any long-term medical conditions, for example, taking blood pressure readings, living with respiratory conditions or managing diabetes.
Ask you to complete online questionnaires as part of medical reviews, e.g. asthma or contraception reviews.
Obtain your feedback on your experience (Friends and Family test).
Support anyone with hearing difficulties or other sensory impairments by offering an alternative way to contact us.

Please be assured that if you cannot receive text messages or choose not to, you can continue to use other communication methods, e.g. phone calls or visits to the surgery.

Your Details

Name *

Date of Birth (DD/MM/YYYY) *

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.

YOUR CONSENT

We need to have your consent to begin communicating with you by text or email.

Please confirm your consent by ticking to accept the options below. *

I consent to the Practice contacting me by text message or email for the purposes of health promotion, Practice news and for appointment reminders.

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 wtih me.

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.

I understand that I can cancel the test message facility at any time.

I consent to the practice collecting and storing my data from this form.

The information you provide on this form will be sent to our practice and used only to deal with your request. Depending on the form, this may include your contact details, personal information and health information. The practice may add it to your medical record and, where needed for your care, share it with other NHS and care services. To find out how we protect and use your information, please read our privacy policy on our website.

I confirm the information I’ve given is correct and I understand how it will be used

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Page last reviewed: 01 October 2024
Page created: 13 October 2026

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Communications Consent Form

We need to have your consent to begin communicating with you by text or email.

Further Information