Flu and COVID Boosters Autumn 2024

Dear Patient, We will be starting our vaccine programme at the practice from October. We will be offering Flu and COVID vaccines to all those eligible. We will be able to administer these in the same sitting. Please note, if you would like to have your vaccines separately at different times we are also able

Gade Surgery > Forms > Keep us up to Date > Communication Consent Form

Communication Consent Form

We would like to keep be able to send you Practice communications by email and text message, but first we need your permission. Please provide your details and consent below. Do not use this form if you are not the patient. If you are a Carer or Patient’s representative please contact the Practice for advice.

Communication Consent

First Name *

Last Name *

Email *

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Mobile Phone Number *

Your Consent

We need to have your consent to begin communicating with you by text or email. Please tick to accept in the boxes below.

I consent to the practice contacting me by text message or email for the purposes of health promotion, practice news and for appointment reminders.

I acknowledge that appointment reminders by text are an additional service and that they may not be sent on all occasions but that the responsibility for attending appointments or cancelling them still rests with me.

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.

I understand I can cancel the text message facility at any time.

Privacy Policy

This form collects your name, date of birth, email and other personal information. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. 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.

Patient’s Signature

Clear

Health A-Z

Guide to conditions, symptoms & treatments

Health A-Z

Live Well

Advice, tips and tools for health & wellbeing

Live Well

Medicines Guide

How medicine works & possible side effects

Medicines A-Z

Care & Support

Options & where to get the best support

Services directory

Flu and COVID Boosters Autumn 2024

Communication Consent Form

Your Consent

Privacy Policy

Health A-Z

Live Well

Medicines Guide

Care & Support

Gade House

Witton House