Electronic patient record consent/dissent

Use this service to have your consent or dissent recorded for your electronic patient record.

You can use this service if you:

• 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

Start now

You can also phone us on 1 The Avenue 01285 653122 or 1 St Peter’s Road 01285 652944.