Citizens Advice Appointment Request

Our colleagues at Citizens Advice offer our registered patients free, independent, confidential and impartial advice to our registered patients at Lake Road surgery in Verwood on second Wednesday mornings or at Pennys Lane, Cranborne on fourth Wednesday mornings each month.

Last Updated: 08/09/2021

Registered Patient Details

The person attending the appointment must be registered as a patient at Cranborne or Lake Road surgery Verwood.

Name *

Date of Birth *

Phone Number *

Email Address

Appointment Request details

(Penny's Lane sessions are offered in an upstairs office, so those with limited mobility should consider booking a slot at Lake Road.)

Required venue *

Any other information (Practice Staff other will be able to read these comments)

THIS 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. *

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Citizens Advice Appointment Request

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