E-mail and SMS consent form

Last Updated: 14/04/2021

Your Details

Name *

Date of Birth *

Mobile Number *

Email Address *

I CONSENTTO PARK END SURGERY CONTACTING ME BY SMS *

Yes No

I CONSENT TO PARK END SURGERY CONTACTING ME BY E-MAIL *

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.

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E-mail and SMS consent form

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