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Patient's Details
Identification Upload

Patient Identification 

Please upload one form of ID as per the list below

We will not store these documents and we will securely delete / destroy them after our initial verification.

Acceptable Identification: Photo Driving License, Passport, Residency card (for children a birth certificate is acceptable).

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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