This practice, by necessity, collects personal and intimate details about its patients. Often patient’s relatives and friends call to enquire about patient’s wellbeing or to offer assistance in the patient’s care. Please select the most appropriate option below to indicate your preference:
I DO NOT want any information about my being a patient in this practice communicated to any family members or friends. I want to be the ONLY person who communicates with the practice about my medical condition.
I freely give my consent for this practice to communicate to family members and friends about the fact that I am patient of this practice and to discuss my health and personal information relating to my being a patient of this practice as the need arises.