SMS Text Consent Form

If you would like us to send SMS appointment reminders by text and to send patient information, letters and test results (when agreed with the GP) please complete this form.

Consent for SMS messaging is recorded in the patient electronic record and we are unable to offer this service without consent.

Last Updated: 03/02/2022

Your Details

Name *

Date of Birth *

Mobile Number *

Email Address *

I consent for Firs House Surgery to send appointment reminders and contact me via the SMS text service *

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.

SMS Text Consent Form

Further Information