Summary Care Record Opt Out

Use this service to opt out of your summary care record.

Your summary care record includes details of any medicines you are taking, any allergies you suffer from and any bad reactions to medicines that you have had.

It also includes your name, address, date of birth and your unique NHS number to help identify you correctly. Additional information can also be added to your summary care 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

You can also phone us on 0118 969 0160.

Section A

If you are filling this form on behalf of another person or child please ensure you fill their details in section A and your details in section B.
What is your name?
For example, 31 3 1980
DD slash MM slash YYYY
Address (including postcode):
Anyone else with access to your email account may see responses sent to you

Section B

If you are filling this form on behalf of another person or child please ensure you fill their details in section A and your details in section B.