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Podiatry New Patient Application Form
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Type 1 Opt-out form
Valid forms of Photo ID need to be provided with all online applications.
Due to COVID guidelines, we are asking patients to submit their completed forms electronically. This means printing off the relevant forms, completing them by hand and either scanning them or by taking a photo of each of the completed pages and emailing them back to us. Please also include copies of your ID. Email completed forms to; email@example.com
We will then complete this process with a phone call to each of the patients requesting access. All copies of ID will be deleted as soon as the process has been completed.
For those patients who can not return these documents electronically, please post all completed forms and copies of relevant ID directly to the surgery (or pop them in the post box located on the wall outside the practice).
Online Access Patient Leaflet
Online Access Request Form
Online Access PROXY Request Form CHILDREN
Online Access PROXY Request Form