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Contact Consent form

Zoë’s Place Baby Hospice would like to continue communicating with you in order to keep you updated.

Due to new government legislation we are no longer permitted to communicate with you unless you confirm you are happy for us to do so.

Please complete the below form ensuring you inform us of the types of communication you are happy to receive and how you would prefer to receive it and we will ensure that we amend our systems to comply with your wishes.

I am happy for my data to be used for the reasons I have selected below

I am happy to be contacted via the methods I have selected below

Please complete your personal details and select the boxes below to indicate why and how you would like us to contact you

I understand that you will not share my details but you may wish to contact me occasionally and I am happy for my data to be used to contact me about: