SMS Reminder Form - Sorrel Bank Medical Practice

TEXT REMINDER CONSENT FORM

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.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Page last reviewed: 09 July 2020
Page created: 11 June 2020

Cookies on the Sorrel Bank Medical Practice website

TEXT REMINDER CONSENT FORM

TEXT REMINDER CONSENT FORM

Further Information