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NHS Funded Patient Consent Form

Please fill out the form below.


NHS Patient Consent & Covid 19 Form
I understand that my doctor will be informed of my attendance and progress. I understand that it is my responsibility to attend my appointment and that if I fail to attend or give adequate notice (24 hours) I may be discharged and my doctor notified.
Medical Checklist.
We ask these questions for your safety. Please contact us or ask at your appointment if you have any queries or are uncertain.
Have you had any of the above? If Yes, please select.
Covid - 19 Checklist
You will needs to select a response for each question
Exceptions to wearing face mask may apply.
Covid - 19 Checklist
Please check that all your information is correct before submitting.