Prospective Record Access Opt Out Form

Please complete this form if you do not want to view your medical records online, but would still like to maintain an account where you can order your repeat prescriptions and book appointments.

Last Updated: 04/09/2023

Patient Details

Surname *

Firstname *

Date of Birth *

Address *

Would you like to opt out of viewing your medical records on the NHS App/Website and Patient Access? *

Yes, I would like to continue to be able to book appointments and order prescriptions, but I do not want to view my consultations, letters, test results etc.

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Prospective Record Access Opt Out Form

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