The data held in your GP medical records is shared with other healthcare professionals for the purposes of your individual care. It is also shared with other organisations to support health and care planning and research.

If you do not want your personally identifiable patient data to be shared outside of your GP practice for purposes except your own care, you can register an opt-out with your GP practice. This is known as a Type 1 Opt-out.

Type 1 Opt-outs may be discontinued in the future. If this happens then they may be turned into a National Data Opt-out. Your GP practice will tell you if this is going to happen and if you need to do anything. More information about the National Data Opt-out is here.

You can use this form to:

  • register a Type 1 Opt-out, for yourself or for a dependent (if you are the parent or legal guardian of the patient) (to Opt-out)
  • withdraw an existing Type 1 Opt-out, for yourself or a dependent (if you are the parent or legal guardian of the patient) if you have changed your preference (Opt-in)


This decision will not affect individual care and you can change your choice at any time, using this form. This form, once completed, should be sent to your GP practice by email or post.

Register your Type 1 Opt-out preference
Details of the patient

Title*

Title*

Forename(s)*

Forename(s)*

Surname*

Surname*

Your Email*

Your Email*

Your Address*

Your Address*

Your Telephone/Mobile*

Your Telephone/Mobile*

Your Date of Birth*

Your Date of Birth*

NHS Number (if known)

NHS Number (if known)

Powered by Survey Maker

Details of parent or legal guardian
If you are filling in this form on behalf of a dependent e.g. a child, the GP practice will first check that you have the authority to do so. Please complete the details below:

Name

Name

Your Address (leave blank if same)

Your Address (leave blank if same)

Your Telephone/Mobile

Your Telephone/Mobile

Your Date of Birth

Your Date of Birth

NHS Number (if known)

NHS Number (if known)

Relationship to patient

Relationship to patient

Powered by Survey Maker

Your decision

Please select*

Please select*

Your declaration*

Your declaration*

I would like to receive future updates from the surgery*

I would like to receive future updates from the surgery*

Powered by Survey Maker

Please note:

This form is sent to Whitestone Surgery via e-mail. Please do not use this form to submit clinical Information, or to request or book appointments. Our practice policies and up-to-date information leaflets are on display in reception. For more information regarding our suggestions and complaints procedure click here. To view our privacy policy, please click here.

Whitestone Surgery

Please contact us at:

82 Bulkington Lane
Nuneaton
CV11 4SB

02476 641911

Click here to find us on the NHS website
Facebook Twitter Envelope

Latest News

Latest Tweets

© Copyright - Whitestone Surgery

Top