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Under the new GDPR (General Data Protection Regulation) rules that came into force on the 25th May 2018 we now require you to actively give us permission to store your information, contact you and pass information about your care onto third parties or other people you may wish to be involved with your care.

Please complete the form below and submit online prior to your consultation. Please note this information is only used with regards to you care and medical treatment and we do not use any information for marketing purposes or share any data with marketing organisations.

We hold your information carefully and safely in order that your privacy is protected. Please visit our Privacy Page for more details.

Your Consultant
Your Details
Your Address
Your Contact Details
Tick to give your permission
for Urology Partners LLP to contact you using the following methods
Urology Partners LLP will ONLY discuss aspects of your treatment (including times of appointments and procedures) with yourself and any other third party involved in your treatment. If you would like us to be able to talk to any members of your family or close contacts, please list these in the box below to confirm your permission. By giving your permissions for methods of contact below, we will only use these methods to contact you with regards to your treatment at Urology Partners LLP. Please note that all personal information that we will hold is only used for your medical treatment and is not used for any marketing purposes
Who Can We Talk To?

If there are members of family or friends who need to discuss your clinical treatment with us, please confirm who we can speak to in the boxes below

Please tick one box below (For insured patients only)
I give my permission for Urology Partners to pass relevant information to my medical insurance company. This may be either verbal or in written form and may include details of my treatment, copies of clinic letters and test results.
Please tick one box below (For all patients)
I give my permission for Urology Partners to pass relevant information to any third party involved in my treatment. This may include my GP, clinicians and other relevant medical professionals. This may be either verbal or in written form.