Consent to receive texts and e-mails from the surgery – Drs Adey & Dancy Tarporley Health Centre

Title*
Name*
First Last
Date of birth*
DD slash MM slash YYYY
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code
Home Telephone Number*
Mobile Telephone Number*
We use a messaging service so GPs and other staff are able to send you a text message from our clinical system. For example to send advice, remind you to book appointments, leave a message if we fail to get through and more. Please let us know your preference and note that we do not share your information with anyone else.
Do you consent to receiving text messages from the surgery?*
- Yes I consent to receiving text messages
- No I do not consent to receive text messages
Email*
We can also email you from the messaging service. Please let us know your preference and note that we do not share your information with anyone else. Please note we can only email patients who have their own individual email address. If you share your email address with another person please do not give consent.
Do you to consent to receiving e-mail communication from the surgery?*
- Yes I consent to receiving e-mails
- No I do not consent to receive e-mails