Your permission to speak with another on your behalf
This consent form grants permission for both clinical and administrative staff within Meadowbridge Surgery to speak to another on your behalf. This may include relatives, friends, carers, etc.We therefore request that you complete this form appropriately and return it to Meadowbridge Surgery where a copy will be filed within your medical record for future reference.
Withdrawal of your Consent
This withdrawal form removes any previous permission granted for both clinical and administrative staff within Meadowbridge Surgery to speak to another on your behalf. We therefore request that you complete this form appropriately and return it to Meadowbridge Surgery were a copy will be filed within your medical record for future reference.