If you wish to give consent to a relative / carer to contact the Practice on your behalf, we will need a signed consent form to be completed by the you (the patient) and the named person you are giving consent for.
The form must normally be returned to the practice by the patient in person, along with valid photographic identification (Photo ID).
If the patient is elderly or housebound and unable to attend in person, a relative or carer may return the form on their behalf. In such cases, the practice must first obtain verbal consent from the patient by telephone before processing the request.
Please ensure the patient is available to confirm their consent by phone at the time the form is submitted.
You can get a printed copy from Reception and return it to us once it has been completed and signed.
Alternatively, you can print a copy of the form below and bring it to the Practice.
Consent Form for Relatives and Carers.doc 2025-07-28 09-38-09-670