Lyme Bay SMS Text Messaging Consent Form

Complete and submit this form to sign up for the Practice SMS Texting Service. The Texting Service allows you to receive confirmations and reminders about your appointments and details of health promotions and other special clinics that may interest you.

The SMS service should not be solely relied upon, as the responsibility of attending and cancelling appointments still rests with you, but we hope this will make things easier.

An NHS secure service generates messages; however, they are transmitted over a public network to a personal phone.

Your Details

Name *

Date of Birth *

Mobile Number *

Email Address

Do you consent to the practice contacting you by text message for the purpose of health information and appointment reminders, and that you will ensure that you keep the Practice informed of your up to date mobile number at all times, or if the number is no longer in your possession. *

Yes

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. *

I consent to the practice collecting and storing my data from this form.

The information you provide on this form will be sent to our practice and used only to deal with your request. Depending on the form, this may include your contact details, personal information and health information. The practice may add it to your medical record and, where needed for your care, share it with other NHS and care services. To find out how we protect and use your information, please read our privacy policy on our website.

I confirm the information I’ve given is correct and I understand how it will be used

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Page last reviewed: 12 August 2022
Page created: 14 October 2026

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Lyme Bay SMS Text Messaging Consent Form

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