Summary Care Record Opt Out Form

Unless you OPT OUT, your basic details (Name, Contact Details, Medication & Allergies) will be stored on a national database and be accessible to other health professionals. Your permission to view this information will be requested where possible.

If you DO NOT want a Summary Care Record please fill out the form below or downlaod a copy here and return to Reception.

1Summary Care Record Opt Out Form

If you are filling out this form on behalf of another person or a child, their GP practce will consider this request.


Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


Your Neighbourhood Professionals. Just a Click Away!
Park View Centre, Chester Road North, Brownhills, WS8 7JB
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Your Neighbourhood Professionals. Just a Click Away!
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