Do not turn up at your Practice without an appointment.

Do not turn up at your practice without an appointment. Phone first or follow the advice on our website.

Fill out a simple online form to get advice and treatment by the end of the next working day.

Teenager Consent

First Name *

Last Name *

Email *

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Teenager’s consent to share data

Children, from the age of 12, have a legal right to decide what happens with their data.

The Information Commissioner states:
“In Scotland, a person aged 12 or over is presumed to be of sufficient age and maturity to be able to exercise their data protection rights, unless the contrary is shown”.

Further information from ICO: What rights do children have

Please note that this consent will lapse on your 16^th birthday.

Do you wish to give consent for a parent or guardian to access your data

Yes

I hereby give consent for the undernoted person(s) to receive/discuss my

Results

Medical History

Medication

Authorised Person(s)

Name of authorised person

Address of authorised person

Relationship to you of authorised person

Name of second authorised person (optional)

Address of second authorised person (optional)

Relationship to you of second authorised person (optional)

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. 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.

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Do not turn up at your Practice without an appointment.

Teenager Consent

Teenager’s consent to share data

Authorised Person(s)

Privacy Policy

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