SMS & Email Consent Form - Wycliffe

Last Updated: 15/10/2019

  • Your Details

    Date of Birth
    For example, 15 3 1984
  • Consenting to EMAILS

    I consent to Wycliffe Surgery sending me emails related to my medical care and other aspects of health
  • Consenting to SMS and Texts

    I consent to Wycliffe Surgery sending me sms messages related to my medical care and other aspects of health
  • DATA COLLECTION AND STORAGE

    This form collects your name and date of birth and other personal information. This is to confirm that you are registered with Wycliffe Surgery and to allow the practice team to contact you. Please read our privacy policy to discover how we protect and manage your submitted data.

    To submit this form now, please complete the following
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