Upload images requested by a Clinician Please do not upload images unless you have spoken to our team first. Images will then become part of your confidential medical record and maybe shared with other health care professionals for advice. Any images sent that do not relate to the condition discussed will not be dealt with and will be deleted. Please do not send any intimate images.Name First Last Email Enter Email Confirm Email Date of Birth DD slash MM slash YYYY Telephone number for us to contact youClinician Requesting ImagesPlease specify which Clinician is requesting imagesDr AliDr ButlerDr DonnellyDr EntwistleDr MaxwellDr McGregorDr MurrayDr TorlesseOtherPlease provide a brief history your condition:File Upload – No more than 3 photos to be uploaded. Please do not send any images of an intimate area. Drop files here or Select files Max. file size: 50 MB. Privacy Policy I consent to the practice collecting and storing my data from this formThis form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data. I understand images sent to the practice without instruction by either admin or clinical staff will be deleted and not dealt with.
