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The Lyndhurst Surgery 53 Lyndhurst Drive, Leyton, London, E10 6JB Tel no: 020 8539 1663 Fax: O20 8556 1977Signing Up For Our Patient Reference Group If you are happy for us to contact you periodically

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1. Obtain the form from Lyndhurst Surgery either in person or via their website.
2. Read the instructions provided on the form carefully.
3. Fill in your personal information such as name, address, contact details, and date of birth.
4. Provide any relevant medical history or information requested on the form.
5. Sign and date the form where required.
6. Double-check all the information provided and make sure it is accurate and complete.
7. Submit the form to Lyndhurst Surgery either in person, via mail, or electronically as instructed.

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1. Individuals who are seeking medical treatment or services from Lyndhurst Surgery.
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