News

Posted on August 13th, 2020

Information about your Summary Care Record Dear Patient, If you are registered with a GP practice in England you […]

Posted on June 29th, 2020

Please do not delay getting health care. If you need urgent medical help and it is not an emergency, […]

Posted on June 1st, 2020

Our New Computer System On Wednesday 22nd July, we will be moving to a new clinical computer system. The […]

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Consent to Summary Care Record

Name
First Last
Address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
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Yes – I would like a Summary Care Record and express consent for medication, allergies, adverse reactions and additional information
- YES
Yes – I would like a Summary Care Record and express consent for medication, allergies and adverse reactions only
- YES
No – I would not like a Summary Care Record
- NO
Express dissent for Summary Care Record (opt out).
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If you are filling out this form on behalf of another person, please ensure that you fill out their details above; you sign the form above and provide your details below:
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