Update Contact Details

Update Contact Details - (aged 16+)

Please use this form to update your contact details if you were requested to do so by Peverell Park Surgery (for Patients Aged 16+ years only).

Name(Required)

First Last

Date of Birth(Required)

Mobile Phone Number(Required)

Email(Required)

Enter Email Confirm Email

Can we contact you by text?(Required)

Yes

Can we contact you by email?(Required)

Yes

What happens to my information?

Personal and medical information about patients registered at Peverell Park Surgery is primarily kept electronically, although some is kept in paper form. Some information will be sent to hospital consultants and other health professionals to whom you are referred by your GP in order to provide continued healthcare and obtain treatment for you. We sometimes use accredited suppliers for our communication with you (please refer to our Privacy Policy), for example when we send recall letters for review clinics or medication reviews. All suppliers we use are checked carefully to ensure they comply with strict confidentiality protocols. To ensure the security of all patient information, all staff that has access to your records is covered by confidentiality clauses in their contracts and the Data Protection Act and the Freedom of Information Act. Our guiding principle is that we hold your records in strict confidence.

Consent(Required)

I certify that the information I have provided is correct and consent to my personal and medical information being used as stated above.

This field is for validation purposes and should be left unchanged.

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