Please use the form below to give us email addresses and/or mobile numbers for yourself and other
 family members  living at the same address. These contacts will be used to remind you of your           
 appointments, to invite you to see a Doctor or a Nurse if you are due for a review and to inform you     
 of any events such as Flu vaccination clinics.                                                                                                 

Using emails is quicker than sending postal letters and more environmentally friendly.                          

Email address and Mobile number Submission
Please list
other family members with their email address

Home Address

First line of your address    
Post code                           

Name D.o.B Email Mobile Consent


Terms & Conditions

By ticking the Consent box the surgery will use the contacts given above for clinical invites and appointment reminders.
For people who are over 16 years of age, please provide a contact that is unique to you, if you share the same Mobile or Email with another adult in the family then each member must contact the surgery to give their explicit consent before we can use it for communications.
If you have a Carer, or you Care for someone registered at Swallowfield Medical Practice then contact our reception team to provide contact names and communications details.

*I accept the terms and conditions above