YCC Opt Out – Victoria Road Surgery

Your Care Connected Opt-Out

Please complete this form if you do not want your information to be shared. If you wish to opt out on behalf of a child or vunerable adult, you must put the request through this form. However, we may decline your request if we believe it is not in the best interests of the child or vunerable adult in question.

Title

Full Name

Date of Birth

Postcode

NHS Number

Confirmed opt out

I do not want my information to be shared via Your Care Connected. I understand that this may mean important information will not be available to those treating me when making decisions about my treatment in potentially urgent and life-threatening situations. I understand that by opting out of Your Care Connected I will also opt out of any other local sharing initiatives by default. I also understand that if I change my mind I can only opt back in by visiting my GP Practice.

I have read and agree to the website privacy policy

Your Care Connected Opt-Out

Copyright:Victoria Road Surgery

Copyright:

Victoria Road Surgery