Enhanced summary care record opt in

Full Name *

Date of Birth *

Please use this date format: DD/MM/YYYY.

Email Address: *

Consent *

I consent to the practice changing my preference to providing a summary care record with additional information

Signature: *

Date:

If you require any more information, please visit NHS Digital.

You can also phone NHS Digital on 0300 303 5678 or speak to the GP Practice.

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