Contact Details Form RMP

Contact Details Form RMP

If you have received a letter please complete this form.

  • Patient Details

    The person whose records another individual(s) is to be given access to

    Date of Birth
    For example, 15 3 1984
  • Other details

    Carer (optional)
    Communication Needs (optional)
  • Letter/Phone/TXT/SMS/Email

    You may receive information by letter, phone, TXT/SMS or email. The information sent may be about appointments, results, referrals, messages about your specific health needs (e.g. a flu vaccination or health care plan) and general infortmation and updates that could benefit you. The responsibility for attending and cancelling appointments, collecting prescriptions and obtaining results still rests with you though. It is also your responsibility to ensure that you have the appropriate security settings on your phone, tablet and/or computer to maintain the privacy of any messages.

    Please tick which is your preferred method of contact (optional)
    The information recorded above is accurate to the best of my knowledge and I take full responsibility to inform Ravenswood Medical Practice if my contact details change in the future.
    Please select todays date
    For example, 15 3 1984
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Page last reviewed: 27 June 2024