Use this service if you wish to grant a representative the ability to communicate with us about you and your health.
Completing this form will enable the person(s) of choice to gain access to information about you and your medical problems, talk to us about your care, and give and receive information about you.
You can use this service if you:
- are registered at the surgery
Before you start
We’ll ask you for:
- your first and last name, date of birth, sex, postcode, email and phone number
- if applicable, the details of the person you are completing the form on behalf of
You can also phone us on Phoenix Cirencester 01285 652056 or Phoenix South Cerney or Phoenix Royal Agricultural University or Phoenix Kemble or Phoenix Tetbury .