OOSO CSS Grid Consent Form

Become a Member of OOSO

To comply with the European Union's General Data Protection Regulation (GDPR) we are required to obtain your consent to store your details.

You can change your mind at any time by sending an email to info@OOSO.org.uk.

We will treat your information with respect. For more information about our privacy policy please click here.

By clicking the SUBMIT button below, you agree that we may process your information in accordance with these terms.

Patient's Details

Patient's first name

Patient's last name

Enter None or N/A if you are not connected to a specific patient

Date of birth (dd/mm/yyyy)

Date of surgery (dd/mm/yyyy)

Patient's consultant

What Was Said Between Us

OOSO will use this information for analysis. For example, it helps when fund raising to show the number of patients year on year. It can also help the medical team to know the number of telephone calls that we handle out of normal working hours.

Yes

OOSO may store summaries of contact with me

Spouse's (or Other) Name

First name

Last name

Connection to patient (Wife, Friend, etc.)

You are the ...?

Carer Other

OOSO Newsletter

Yes

Please add me to the OOSO Newsletter distribution list

(Click YES, above, to add your email address to the newsletter mailing list.)

Email

Confirm

(We will use this email address to confirm that we have received the details.)
(If you do not receive a confirmation, please check the email entered above.)

Postal Address

House name

Line 1

Line 2

Town

County

Post code

Telephone Number

Home phone number

Mobile phone number

To Confirm