Call us: 01524 843333

Email: [email protected]
Address: 2 Queen Square, Lancaster, LA1 1RP

Patient Consent

The following form will give permission for Queen Square Surgery to share information regarding your medical wellbeing and any test results with the nominated individual.

Patient Consent Form

Please submit the completed form via email or give a copy to reception; please note it will need to be signed if submitted electronically for us to accept it.