Submission of email address and mobile number

This page is intended for patients to submit to the surgery, their email address and an up to date mobile telephone number. By submitting the information to us, you are giving patient consent to accept information via e-mail and SMS text messages.

Benefits of the service

We will be in a position to send e-mails regarding

  • your test results
  • health information relevant to you
  • appointment reminders
  • flu clinics
  • cervical screening
  • blood pressure and cholesterol monitoring.

How to use the service

We ask you to complete the form below giving us your email address and mobile phone number as appropriate. Alternatively, if you would prefer, you can complete a form at reception when next at the surgery.

Once we have the completed form, we will update this information on your patient record and then send you a confirmatory e-mail acknowledging receipt of the correct e-mail address. If you do not receive a confirmation message with four weeks, you will need to contact us to ensure your record has been updated with the correct information.

How your information is stored

We will hold your email address within your clinical notes and will not release your e-mail address to anyone else as this would breach your patient confidentiality. All e-mail's and SMS messages are handled manually and are not automatic. It may therefore take several days to get back to you, as we have to deal with many issues during the course of a typical day at the surgery.

Please note
We are only able to email and text message information relating to the owner of the e-mail address or mobile number. We are unable to send information relating to other patients, even if these are members of the same family. This is for confidentiality reasons. Neither are we able to discuss clinical matters or illness via e-mail

The e-mail address that you provide to the surgery on this form must be one that is accessed on a regular basis since information may be sent to you that requires your action. All e-mails and text messaging are "no-reply" messages and responses to the surgery e-mail and text messaging system cannot be answered. Please contact the surgery directly if you have a concern.

Your details for identification

Entries marked * are compulsory
Surname*:
First name*:
Date of birth for identification*:
Street name or house name for identification*:

Your email address and/or mobile as appropriate

Email address:
Please confirm your email address by entering it again:
Mobile number:
Please confirm your mobile number by entering it again:

Anti spam verification

please enter the name of the city EXACTLY as you see it *

Please tick the consent box