GROVE MEDICAL PRACTICE MAIN SITE CROMWELL PLACE SITE ST

150 NORTHWEST POINT BLVD 4TH FLOOR ELK GROVE VILLAGE
150 NORTHWEST POINT BOULEVARD 4TH FLOOR ELK GROVE VILLAGE
2431 CURTISS STREET DOWNERS GROVE ILLINOIS 60515 FOR IMMEDIATE

41 POPLAR GROVE AND THE EMORYS A PRELIMINARY HISTORY
BROMSGROVE DISTRICT COUNCIL (OFFSTREET PARKING PLACES) (CIVIL ENFORCEMENT AND
BROMSGROVE DISTRICT COUNCIL ALLOTMENT TENANCY AGREEMENT PARTIES (1) THE

CROMWELL PLACE

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