Text Message Consent Form

Text Message Consent Form

The Practice offers a text-messaging service which is linked to your registered mobile phone number.  Examples of things it can be useful for include:

  1. to send appointment reminders, 24 hours before a scheduled face-to-face appointment with any member of the Practice team.
  2. to send general information during or after a consultation, such as a website link.
  3. to ask you to call the surgery if we need to discuss something with you. 
  4. with your express permission, to use the service to send you more sensitive medical information, such as test results, instructions about medication, or short messages about your medical condition.  

If you would like to make use of our text-messaging service for purposes mentioned in Options 1 to 3 above, please complete this consent form. 

Due to the confidential nature of the types of information mentioned in Option 4 above, if you would also like us to use our text-messaging service for those purposes, we require your separate, explicit, consent to do so.  You will be unable to submit the consent form if do not answer that question. 

  • Your Details

    Date of Birth
    For example, 15 3 1984
    I consent to the Practice contacting me by text message for such purposes as described in Options 1 to 3 above.
    I consent to the Practice using its text-messaging service to send me confidential information, such as that described in Option 4 above.
    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.
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Page last reviewed: 12 March 2026
Page created: 04 March 2026