Grove Medical Practice
Main site: Cromwell Place site, St Ives, Cambs, PE27 5JD
Tel: 01480 462206 website: www. grovemedicalpractice-stives.nhs.uk
Branch site: Old Exchange site, St Ives, Cambs, PE27 5PB
Tel: 01480 497477 website: www.theoldexchangesurgery.co.uk
Date:
Dear Patient
Under GDPR (General Data Protection Regulations) the practice now need to gain your written consent to pass your details onto the new committee to allow them to contact you directly. You will only be contacted in connection with PPG business.
Going forwards a “virtual” group may also be set up for members who are unable to attend but who wish to be kept informed. This will be conducted via email, and again we need written permission for you to be contacted in this way.
I would be most grateful if you would please complete the attached sheet, sign it and return it to the surgery for my attention as we need an original copy on file.
Many thanks
Anne Roberts
Data & Systems Manager
Grove Medical Practice
CONSENT TO CONTACT
I ………………………………………………………………………………………….……………(Please print name)
give my consent to Cromwell Place Surgery to pass the following information to the Chair or Secretary of the Cromwell Place Patient Participation Group (PPG) for the purposes of contacting me in connection with PPG business.
I consent to the following information being provided to the Committee by Cromwell Place Surgery:
MEANS of CONTACT |
DETAILS |
YES / NO |
Eg Home Telephone |
0123456789 |
YES |
|
|
|
Home telephone number
|
|
|
Mobile telephone number
|
|
|
Text message on above
|
|
|
Email address
|
|
|
Home address via post
|
|
|
If you do not give your permission to be contacted by the Chair & Secretary we will assume that you no longer wish to be a member of the PPG and will delete your contact details from the members list. |
Signed:…………………………………………………………………………. Date: ………………………………………..
Partners: Dr Basuita, Dr Chen, Dr Gayton, Dr Jessop, Dr Leonard,
Dr Mendoza, Dr Moffat, Dr Pritchard & Dr Somers Heslam,
BROMSGROVE DISTRICT COUNCIL BROMSGROVE ENGAGEMENT & EQUALITIES FORUM SMALL
BROMSGROVE DISTRICT COUNCIL BY – ELECTION ALVECHURCH VILLAGE THURSDAY
CAROLINA PEDIATRICS 2113 ADAMS GROVE SUITE 101 COLUMBIA SC
Tags: cromwell place, by cromwell, cromwell, grove, medical, practice, place