Acceptable Behaviour Contract

Page {{ paginatorProps.current }} of {{ paginatorProps.total }} ({{ paginatorProps.percentage }}% completed)

We are committed to promoting access to our services and offering choice wherever possible in the services we provide and the way we deliver them. An acceptable behaviour contract is an individual written  agreement between a patient and their GP practice.

The contract is between the patient named in the following section and Westcourt Medical Centre, and is valid from the date this form is submitted.

Westcourt Medical Centre will ensure you are dealt with quickly, fairly and in a courteous and helpful manner.

Westcourt Medical Centre will ensure that staff take responsibility for resolving or dealing with your query or that they refer it to an appropriate colleague.

The Conditions:

The person applying for registration at the practice agrees to the following:

  1. To refrain from using abusive or offensive language, making threats of violence or aggressive behaviour and to treat all staff fairly and with respect; in person, on the phone, in writing or on social media.
  2. To cancel any appointments they are unable to attend with as much notice as possible.
  3. To Westcourt Medical Centre’s DNA (Did Not Attend) policy - if they miss three appointments without notifying the surgery, they may be removed from the practice list and will have to register with a different  practice.
  4. To adhere to Westcourt Medical Centre’s repeat prescription policy and agree to allow 3 working days before collecting repeat prescriptions.

Breach of this Contract:

If the above-named person fails to adhere to the above conditions, they may be removed from the practice list. This contract serves as an initial warning in the event of breaches occurring.

Processing

All questions marked with a * are mandatory

Personal Details
Please double check you've entered the correct email address
Processing
Declaration

Declaration:

I confirm that I understand the meaning of this contract and that the consequences of breaking the conditions of the contract.

Processing

Privacy Consent

Processing

There appears to be a problem loading the form, please refresh the page.
If the error persists please contact us.