SMS Text Reminder Consent Form

Please provide your consent for us to send you SMS text reminders - these may be for appointments, test results or upcoming vaccination clinics.

I consent to the Practice contacting me by text message for the purposes of appointment reminders, results, action needed following test result or invitation to clinic.

I acknowledge that text messages 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 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.

Last Updated: 28/01/2022

Your Details

Name *

Date of Birth *

Mobile Number *

Email Address *

Do you consent to receive your test results from the surgery via text message (where appropriate)?

Yes No

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. *

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 Birchgrove Surgery website

SMS Text Reminder Consent Form

Further Information