Local Opt Outs

Please ensure you have thoroughly read the information on the 'Patient Record' page of our website before submitting this form.

We strongly advise that no-one opts out of local data sharing as to do so could have negative implications on the efficiency and immediacy of your treatment if you need the services of an out of hours GP, a community based health provider such as district nurses or need to receive emergency hospital treatment.

  • Patient Details

    Date of Birth
    For example, 15 3 1984

  • Opt Out

    I confirm I have read and understood that opting out of 'Local Record Sharing' may impact the efficiency and immediacy of my treatment.

  • Identity Confirmation

    Confirmation
    Date:
    For example, 15 3 1984
The information you provide on this form will be sent to our practice and used only to deal with your request. Depending on the form, this may include your contact details, personal information and health information. The practice may add it to your medical record and, where needed for your care, share it with other NHS and care services. To find out how we protect and use your information, please read our privacy policy on our website.
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Page last reviewed: 03 June 2026
Page created: 13 October 2026