This form is sent to The Wilberforce Surgery via e-mail. Please do not use this form to submit Personal or Clinical Information.
We will use the information entered into this form only for the purposes of processing your enquiry
and may be in touch with you in relation to the data submitted.
Information entered into this form is emailed directly to us and is processed by designated staff members.
Issues raised in comments may be discussed between relevant members of the Practice.
This information is not shared with any external third party organisations.
This information is retained for up to 60 days.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.
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