Text Reminder Consent Form

If you would like to receive appointment text reminders and the occasional message from the Practice please provide your up to date mobile number.

Please be advised that it is your responsibility to let the Practice know if you change your contact details. You can do this via the form on the website or by contacting the Practice.

Last Updated: 29/04/2024

Your Details

Name *

Date of Birth *

Mobile Number *

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH 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.

Cookies on the Ladywell Medical Centre East website

Text Reminder Consent Form

Further Information