Patient forms / leaflets

Below are links to forms and leaflets you can download or fill in online:

• New patient registration form

• Summary Care OPT OUT Form

• Blood donor registration

• Patient complaint with third party consent

• Peel Hall Medical Practice leaflet

• Peel Hall Medical Practice leaflet (translatable version for different languages)

• Complaints leaflet (download version)

• Complaints leaflet (translatable version for different languages)

• Text Messaging OPT IN – please complete the form below
  OPT IN for text messaging

  How old are you ? *

  Date of birth *

  Do you wish to have mobile text messaging with Peel Hall Medical Practice ? * YesNo

  Do you agree to keep Peel Hall Medical Practice updated with your most recent mobile number for this service ? * YesNo

  Name *

  First

  Last *

  Last

  Contact number *

  Address *

  Address

  Address

  Address

  City

  City

  County

  County

  Postcode

  Postcode

  Please provide us with your mobile. *

  (The number provided will be used by Peel Hall Medical Practice to contact you via text messaging)

  Please always ensure that you keep us informed if you ever change your mobile number for this service.

  Sorry this service currently only available to patients who are 16 years old or above.

  Submit