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Your Personal Details

Your Contact Details

Your Doctor Details

Your Consent

Authorisation of Service

By providing the details above you agree to Smarta Healthcare to contact you about your chosen service. You also agree for us to act on your behalf to liaise with your surgery either by phone, post, in person or electronically and collect your prescription either in person, post or electronically or by Electronic Prescription Service (participating surgeries only).

Contact Permission

We may send you exclusive offers or latest information from Smarta Healthcare by email, post SMS and other means of electronic. We always treat your personal information with care and will never sell to other third party companies for marketing purposes.