Registration Form

We require your consent to collect personal information about you and to use the information you provide in the following ways :-

• Administrative.

• Billing.

• Disclosure to others involved in your healthcare including treating doctors and specialist outside this medical practice.

• Other doctors within this practice.

• Deidentified for research and quality assurance activities.

• To comply with any legislative or regulatory requirements e.g. notifiable diseases.

• For reminder letters which ay be sent to you regarding your health.

Reminder System :

This practice takes a preventative approach to your health. You may receive phone calls, letters or be reminded at your next visit of on-going follow-up for preventative care as well as SMS appointment reminders.
Thank you for taking the time to complete this form.