Register your type 1 opt-out preference

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.

If you prefer you can download an easy-read version of this information: assets.nhs.uk/patient-information

Who are you completing this form for?
For example, on behalf of a child or dependent
What is your name?
DD slash MM slash YYYY
What is your sex?
As recorded on your medical record
What is your postcode?
The one used to register with your GP
Anyone else with access to your email account may see responses sent to you
Address
Please select one of the following:
I confirm that:
Please select one of the following: