Consent to speak on behalf of a family member

We are aware that there are circumstances where a family member will either be incapable of consulting with a clinician or is a child over 16 consenting to their parent speaking for them.

If this is the case, please send us a letter signed by the patient or an email from the patients email address, confirming

1. Patient name, date of birth, address
2. Who they are authorising to speak for them
3. That persons relationship to the patient
4. That they authorise this person to speak on their behalf in a consultation

Alternatively you can send us a copy of your Lasting Power of Attorney document, if appropriate.

Post to: King George Surgery, 135 High Street, Stevenage, SG1 3HT

or

email to: kgsmh.kinggeorgesurgery@nhs.net

We will then make a note of this on the patient record.