Continuation Sickline Request Form
REQUEST FOR A CONTINUATION SICKLINE OR SIGNING OFF LINE
PLEASE NOTE THIS FORM CAN ONLY BE USED FOR ONGOING CONDITIONS, FOR A FIRST SICKLINE PLEASE MAKE AN APPOINTMENT WITH THE DOCTOR.
Information submitted through secure forms is used only for the purposes of processing your request. We may
be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key and is accessed over a secure
connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.