Consent To SMS Messages

As a practice, we are reviewing the way our patient’s receive information about their care. Your GP would like to be able to communicate with you by SMS text. Providing your consent for this will allow us to let you know of important updates of results, referrals, advice etc.

Voicemails are left only when the Practice must get in touch with you.

If you would like to receive SMS messages for a child age 11 and under then please visit the practice.

If you are human, leave this field blank.

Your First Names: *

Your Last Name: *

Mobile Phone Number: *

Email Address: *

I consent to the Practice contacting me by text message, email and voicemail (using my landline) for the purposes of appointment reminders, results, action needed following test results, referrals, health promotion, non NHS work, medication and Practice updates.

I acknowledge that text messages, emails and voicemails are an additional service and that they may not be sent on all occasions. The responsibility for attending appointments and cancelling them as well as contacting the Practice to obtain the results of recent tests still rests with me. I can cancel the text message and/or email facility at any time.

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.

Emails and voicemail will also be generated using a secure facility but I understand that they are transmitted over a public network onto a personal email accounts or landlines and as such may not be secure. We will only send the minimum amount of personal identifiable information needed to convey the message.

Consent: *

I consent to being contacted by SMS messages

I wish to withdraw my consent to being contacted by SMS messages

If you have consented to this method of communication, you can withdraw your consent at any time.

Name as signature: *

Date:

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