The Primary Care Gambling Service Registration Form

Please complete this form to register for the Primary Care Gambling Service. All personal information provided will be handled and stored in full accordance with GDPR requirements.

If you have any problems with this form please contact us, or call 0300 0300 111 during office hours.

Out of office hours, you can also contact the National Gambling Helpline, to arrange a referral – call Freephone 0808 80 20 133 or web chat via the website (available 24 hours a day).

If you would prefer to have this form emailed or posted to you please contact us or call 0300 0300 111 during office hours

Contact Details (most commonly we will contact you by email or by telephone. Please be assured we will always choose the method that is most confidential, safest and best suited to the matter at hand)

From time to time we may wish to communicate with you by text message (e.g. to give you a password for any document we send by non-encrypted email).

By completing and submitting this form you are giving us formal consent that we can make contact with you using the details above.