Skip to content

Privacy Statement & Consent Form

Read the full Privacy Policy here.

I understand that I can, at any time, request that my personal information not be used for these purposes by contacting:

Geraldine Norris
Email:  or
write to me at Plas Mawr Community Centre, Highfields, Blackwood, NP12 1HB

While I remain a patient of Geraldine Norris (and for seven years thereafter.  In case of children, 7 years after their 18th Birthday), I consent to my personal information being used for the purposes detailed above.

Please tick the boxes below to give me permission to use the information you have supplied in the following ways: