Text Reminder Consent Form – Kirton Lindsey & Scotter Surgery

Your Details

Birth Email Name

Name

Date of Birth

Mobile Number

Email Address

Consent

I consent to the practice collecting and storing my data from this form.

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.