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We use the highest possible encryption, 128-bit, to protect the data you share with us. Encryption converts your information into an encoded format before it is sent over the Internet so that is is protected.
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| If you are contacting us on behalf of another person please obtain their consent first, then enter the patient details and then your details at the bottom of the form. |
| Please note : When this form is submitted it may be read by members of staff other than their intended recepient. |
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