Local Opt Outs

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
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Page last reviewed: 03 June 2026
Page created: 03 September 2020