Use this service to give next of kin consent.
We hold your medical record in strictest confidence, and will not discuss your information with anyone, including family members such as husbands, wives, sons or daughters, without your explicit consent.
If you do wish to give (or revoke) your consent for us to discuss you conditions with another person please complete this form. We will contact you to ensure this is a legitimate request.
You can use this service if you:
- your next of kin are registered at the surgery
Before you start
We’ll ask you for:
- your first and last name, date of birth, sex, postcode, email and phone number
- if applicable, the details of the person you are completing the form on behalf of
You can also phone us on 01777 870203.