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Communication Consent

If you would like to consent to receiving text message reminders for appointments and notifications from the Practice, please use this form.
All patients have the right to change their minds and have this service stopped. Please notify Reception – in writing, not text – if you wish to opt out of this service. If you change your mobile number, please remember to let us know.

Full Name:


Date of Birth:


Phone Number:


Mobile Number:


Email Address:


Address and Postcode:


I confirm that I am currently within the UK at the time of sending my enquiry.