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Sharing your Information with Others

Collecting and sharing information is essential to provide safe and effective health care.

Appropriate information sharing is an essential part of the provision of safe and effective care. Patients may be put at risk if those who provide their care do not have access to relevant, accurate and up-to-date information about them.

Privacy and confidentiality when using the NHS

All staff have an ethical and legal duty to keep patient information confidential.

If you do not wish your health information shared please notify the Practice in writing, so we may update your record.

Summary Care Record Opt-Out

Section A – Patient’s Details

Enter Email
Confirm Email
Please use format day/month/year e.g. 12/05/1979
Address
Town/City
County
Postcode
Country

Section B – Complete this section of you are completing the form on behalf of another person or child

Signature

Please sign your name to confirm. You may draw with mouse, stylus, touch or select the “Type It” option to type your signature.
Today’s date is automatically inserted here.

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.