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Patient Communications Questionnaire

We wish to understand and record any particular communication needs you might have.

We will then do our best to meet your needs in all contacts with the surgery.

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Personal Details

Completed By: *

Accessibility Information

Is your communication with others affected by a health problem or disability which has lasted, or is expected to last, at least 12 months?: *

Can we share this information with other health and social care providers?:

If no you do not need to answer any other questions.

Privacy Consent

This form collects personal and medical information about you and 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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Primary Care Network

Providing NHS Services

Budleigh Salterton Medical Centre
1 The Lawn
Budleigh Salterton
Devon
EX9 6LS

Telephone: 01395 441 212