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Whitnash Medical Centre Providing NHS services
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Home > Reception: Steroid Injection Consent Form

Reception: Steroid Injection Consent Form

Please complete this form if you are interested in having a steroid injection at the practice. Prior to completing the form please review in full the information in the link below outlining the benefits and risks of the procedure.

Please do not write any clinical queries on this form. Any clinical queries or request for appointments via this form will be discarded. To make an appointment either book online via the NHS app/Patient access or by calling reception 01926 316711. We will start to process your form by the next working day but it will take up to 3 working days to complete. Please do not call before 3 working days as you will not receive a status update from reception or the administrative team. If you are not a registered patient then your form will be discarded. This service is only for patients registered at the surgery aged 16 and over.

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Reception: Steroid Injection Consent Form
Only one joint can be done at one time.
If you select the option 'I do not want to go ahead' you will not be booked for a steroid injection and you can abandon this form
Please note not all patients will need to be contacted. This will be done on a case by case basis.

Privacy Protection

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.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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Whitnash Medical Centre

110 Coppice Road , Whitnash, Warwickshire, CV31 2LT

  • 01926 316711
  • reception@whitnashmc.nhs.uk
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